Get Ga Dma-613 2010-2025

The GA DMA-613 is an essential form required for the evaluation of applicants seeking admission to nursing facilities in Georgia. This guide provides a user-friendly approach to successfully complete the form online, ensuring compliance with regulatory requirements.

Follow the steps to fill out the GA DMA-613 correctly.

1. Click 'Get Form' button to obtain the form and open it for editing.
2. Complete the resident identification section by providing the name of the applicant and selecting their sex. Ensure to include their date of birth and social security number.
3. Enter details of the submitting facility or office name, including the representative's title and contact information.
4. Indicate the admitting nursing facility and its provider number. Specify the current location of the applicant and check all relevant admission types that apply.
5. Respond to the mental health screening questions. Carefully check ‘Yes’ or ‘No’ for each inquiry related to mental illness and physical conditions, providing additional details as needed.
6. Fill out the diagnosis section. Check all applicable diagnoses for the individual and provide any necessary comments to elucidate the individual’s condition.
7. Have the physician sign the form, including their name, licensure number, and the date of signing. Ensure the completeness of their information.
8. Before submission, review all entries for accuracy. After confirming that all required fields are complete, you can save your changes, download, print, or share the form.

Complete the GA DMA-613 online today to ensure efficient processing of your application.