Get Md Dhmh 4345 2014-2026
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How to fill out the MD DHMH 4345 online
The MD DHMH 4345 form is essential for assessing individuals applying to nursing facilities under the Maryland Medical Assistance Program. This guide provides you with step-by-step instructions to help you easily complete the form online.
Follow the steps to successfully complete the MD DHMH 4345 online.
- Click the ‘Get Form’ button to access the MD DHMH 4345 form and open it in your preferred online platform.
- Begin by filling in the individual’s last name, first name, middle initial, date of birth, and social security number. Be sure to accurately enter the sex and the nursing facility admission date.
- Provide the current location and address of the individual. Ensure that the city, state, and zip code are correctly noted.
- List the contact person, their title or relationship to the individual, and their phone number to facilitate communication.
- Complete the exempted hospital discharge section. Respond to the three questions accordingly and sign and date as necessary if all responses are 'Yes'.
- Proceed to the intellectual disability and related conditions section. Answer the questions about diagnosis, history, and eligibility for services.
- Next, complete the serious mental illness section, providing required details regarding diagnosis, level of impairment, and recent psychiatric treatment.
- If applicable, fill out the categorical advance group determinations section, answering questions regarding convalescent care or severe illness.
- Review all provided information to ensure accuracy and completeness. Once satisfied, submit your responses.
- Finally, save your changes, and download or print the completed form for your records or further processing.
Start completing the MD DHMH 4345 online today to ensure a smooth application process.
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