Get Mn Dhs-1503 2008-2025

Completing the MN DHS-1503 form accurately is essential for ensuring a smooth admission process for long-term care services. This guide provides a step-by-step approach to filling out the form online, making it accessible for all users.

Follow the steps to complete the MN DHS-1503 form online.

1. Click the 'Get Form' button to access the MN DHS-1503 form and open it in the online editor.
2. Begin by entering the provider information in Section 1. Include the long-term care provider’s name, phone number, the provider's reference number if applicable, today's date, and the physician’s National Provider Identifier (NPI). Make sure all entries are accurate.
3. In Section 2, provide thorough recipient information. Document the recipient's name, medical assistance number, birthdate, and if applicable, indicate their status as an applicant by placing an 'X' in the designated box.
4. Fill in the primary diagnosis and corresponding diagnostic code in Section 3. If there are secondary diagnoses, enter them along with their codes in the appropriate fields.
5. Section 4 requires information regarding preadmission screening. Answer whether the person was screened prior to admission by selecting 'yes' or 'no'. If yes, document the screening date and the agency name.
6. Complete the admission information in Section 5. Enter the date of the first admission, select the recommended level of care, and estimate the length of stay by checking the appropriate box.
7. For the physician's signature, ensure that the physician certifies the need for long-term care services in Section 6. The physician or authorized person must provide their signature and the date.
8. Finally, save your changes, and download or print the completed form for your records. Ensure to share the form with the local county agency as required.

Complete your documents online for a more efficient process.