Get Attachment 13, Re-determination Of Icf/mr Level Of Care Does Not ... - Temple

Filling out the Attachment 13, Re-Determination Of ICF/MR Level Of Care Does Not ... - Temple can seem daunting, but this guide will help you navigate each section with confidence. Follow these clear steps to ensure that you complete the form accurately and effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the date at the top of the form, ensuring it is accurate and reflects the date you are completing the re-determination.
3. Provide the individual’s name or the surrogate's name clearly in the designated field.
4. Input the address of the individual or surrogate, making sure to include all relevant details like street, city, and ZIP code.
5. In the section stating 'Dear [Name of Individual or Surrogate]:', write the name of the individual or surrogate, maintaining a professional greeting.
6. Complete the area where it states 'This letter is to notify you of the decision that was made by the Qualified Mental Retardation Professional.' Include the name of the individual being reviewed.
7. Insert the date of the previous letter that was sent to the user regarding the re-determination process.
8. In the specified space, insert the reasons for the decision regarding the individual's ICF/MR level of care after the review.
9. Mention the name of the waiver relevant to the individual's care in the 'Name of Waiver' section.
10. Complete any enclosed forms as noted, like form DP 251, and ensure they are signed if required.
11. Review the document to ensure accuracy and completeness, checking that all necessary fields are filled out correctly.
12. Finally, save changes to the document and choose to download, print, or share as necessary.

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