Get Oh Form 3622 2014-2025

Filling out the OH Form 3622 online is a straightforward process that requires attention to detail. This guide will provide clear and comprehensive instructions to help you through each section of the form efficiently.

Follow the steps to complete the OH Form 3622 online.

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by completing Section A, which includes identifying information for the applicant or resident. Enter the last name, first name, middle initial, sex, date of birth, and social security number. Indicate if the applicant or resident is a Medicaid recipient and provide the Medicaid number if applicable.
3. In Section A, also check the appropriate box for the living arrangement of the applicant or resident, such as independent living or institutional setting.
4. Move to Section B to indicate the reasons for screening. Choose the appropriate preadmission screening or resident review codes as applicable.
5. Fill out Section C to provide information regarding the medical diagnosis. Answer whether the individual has a documented diagnosis as specified.
6. In Section D, complete all questions related to indications of serious mental illness. Provide detailed responses as applicable.
7. Proceed to Section E for indications of developmental disabilities or related conditions. Answer each question thoroughly.
8. Section F focuses on returning to community living. Answer the questions regarding alternatives and expectations for the individual's return to the community.
9. In Section G, if applicable, detail your request for resident review approval for a specified period of time and provide necessary descriptions.
10. Complete Section H by providing mailing addresses for evaluations and contact information for necessary parties.
11. Finish with Section I, entering the submitter information, certifying the accuracy of the information provided, and signing the form.
12. Once all sections are completed, save any changes to the form. You can then download, print, or share the completed form as needed.

Start filling out your OH Form 3622 online today for a smooth submission process.