Get Mn Dhs-5841-eng 2016

The MN DHS-5841-ENG form is designed to facilitate communication about home care services between managed care organizations and county or tribal agencies. This guide will provide clear instructions on how to complete the form online to ensure that individuals receive the necessary services.

Follow the steps to successfully complete the MN DHS-5841-ENG online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the member name, date of birth, and personal medical identifier (PMI) in the designated fields.
3. Enter the diagnosis and guardian name if applicable, along with the MCO staff details and care system.
4. Provide the phone number and fax number for both the MCO staff and the waiver case manager.
5. Select the reason for communication from the available options: providing information, requesting information, or indicating an action required.
6. Indicate the recommended services and specify if it involves an initial request, an increase, or a decrease in services.
7. Detail any special member concerns or comments as necessary in the comments section.
8. If the member is currently on a waiver, enter the waiver authorization dates, including start and end dates.
9. Obtain signatures from the county or tribal case manager and MCO staff, including their phone numbers and dates.
10. After completing the form, ensure all information is accurate, then save your changes. You can download, print, or share the completed form as required.

Complete your forms online today to streamline the communication process for home care services.