SsHealth MMIS # SCO/OC/PACE ID# CDC/VIP SIMS# Care Program: Is Consumer a minor: Yes No Primary Language: Parent(s) of Minor Child: Name: Relationship: Name: Relationship: Previous PCA services / Consumer owned business? Yes No If Yes, EIN: Program Enrolled: FFS: SCO: SCO Agency: One Care: One Care Agency: CCA PACE: PACE Agency: Serenity Care TUFTS SWH CCA UHC Fallon BMC TUFTS East Boston NNHC Uphams Co.
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How to fill out the MA Tempus Unlimited Consumer Referral Form online
Filling out the MA Tempus Unlimited Consumer Referral Form online is a straightforward process that enables users to provide essential information for referral purposes. This guide will walk you through each section of the form, ensuring you can complete it accurately and efficiently.
Follow the steps to fill out the form easily.
- Click ‘Get Form’ button to access the form and open it in the designated editor.
- Enter the referral date in the appropriate field, as this will help track the timing of the referral.
- Provide the TEMPUS assigned consumer number if available; otherwise, leave it blank.
- Fill in the consumer's full name, ensuring it matches their identification.
- Input the consumer's email address for communication purposes.
- List the consumer's phone number, making sure to indicate whether it is a cell or home phone.
- Complete the home address section, verifying that all details are correct, including street address, city, state, and ZIP code.
- If applicable, provide the mailing address in the designated field.
- Enter the social security number, date of birth, and gender. Choose 'M' for male or 'F' for female.
- Fill in the MassHealth MMIS number, as well as the SCO/OC/PACE ID number, if available.
- Specify if the consumer is a minor by selecting 'Yes' or 'No.'
- Indicate the primary language spoken by the consumer.
- If applicable, list the names and relationships of the parents or guardians of a minor child.
- State whether the consumer has previously received PCA services or owned a business by selecting 'Yes' or 'No.' If yes, provide the EIN.
- Select the care program in which the consumer is enrolled, such as FFS, SCO, One Care, or PACE.
- If applicable, provide the corresponding agency's name for the selected care program.
- Fill out the surrogate or authorized person's information, including name, email, phone, address, and relationship to the consumer.
- Specify where the welcome package should be mailed, either to the agency, consumer, or surrogate/AP.
- Indicate whether a hard copy should be mailed to Tempus by selecting 'Y' or 'N.'
- Provide the skills trainer or case manager's name, email, phone number, and extension if applicable. Include fax number as required.
- Review all entered information for accuracy before finalizing the submission.
- Once completed, save changes, download the form, print it if necessary, or share it as required.
Complete the MA Tempus Unlimited Consumer Referral Form online today to ensure a seamless referral process.
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Is Tempus Unlimited a nonprofit?
Tempus Unlimited Inc.is a non-profit agency that was founded in 1952. The agency has grown and evolved over the past 57 years by offering a variety of services to children and adults with a range of disabilities throughout Massachusetts.
How much does Tempus Unlimited pay in PA?
Average Tempus Unlimited hourly pay ranges from approximately $12.49 per hour for In Home Caregiver to $17.90 per hour for Personal Care Assistant. Salary information comes from 142 data points collected directly from employees, users, and past and present job advertisements on Indeed in the past 36 months.
What kind of business is Tempus Unlimited?
Tempus Unlimited is a nonprofit organization that offers family care, recreational, therapeutic, supported living, and employment services.
What is tempus and PCA?
Personal Care Attendants are hired, trained and supervised by the person with the disability (consumer). PCAs do not work for Tempus Unlimited, or any other agency – they work for the consumer. As the employer, a consumer chooses who to hire, sets up a PCA schedule and trains PCAs to meet his or her own personal needs.
What kind of company is Tempus Unlimited?
Tempus Unlimited exists to provide a continuum of community based services that support the efforts of children and adults with disabilities to live as independently as possible in the least restrictive environment.
What is consumer number for Tempus unlimited?
If you have any questions, please contact Tempus Unlimited, Inc. at Toll-Free at 1-877-479-7577 Monday through Friday between the hours of 7:30AM and 4:30PM. One of our Consumer Relations Specialists will be happy to assist you. I am a consumer of MassHealth-approved Personal Care Attendant Services (PCA Services).
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