Get 003730115.doc - Services Dpw State Pa

This guide provides detailed instructions on how to accurately complete the 003730115.doc form related to services provided by the Department of Public Welfare in Pennsylvania. Following these steps will assist users in submitting the form online efficiently and correctly.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the provider name and address section. Ensure that the provider's name (Heartland Home Health Care) and the correct address (P.O. Box 10086, Toledo, OH 43699-0086) are entered clearly.
3. Enter the provider's representative details. Fill in the name of the representative (Marcia Foust) appropriately.
4. List the recipients involved in the case. Fill in the necessary identifiers or names as needed in the provided fields while maintaining privacy.
5. Fill in the department representative's name (John Poe) along with the case number, ensuring it is accurate.
6. Enter relevant dates related to the adverse action. These include the dates the notices were mailed and the date the appeal was received.
7. Detail the hearing information such as the hearing location, date, start time, and end time. For instance, note the date of the hearing (4/20/2004) and specify the location as Plymouth.
8. Complete the order section. After reviewing the recommendations from the Administrative Law Judge, indicate if the recommendations are adopted.
9. Finalizing the form: Review all the information you have inputted for accuracy, ensure there are no missing fields, and make corrections if necessary.
10. After completing the form, save any changes, and download it where applicable. You can also print the form or share it as required by your needs.

Complete your documents online to ensure timely submission.