Follow the steps to fill out the NH BEAS 3540 online.

1. Click the ‘Get Form’ button to obtain the NH BEAS 3540 form and open it in your online editor.
2. Begin by filling in the ‘Advance Payment’ section with the amount required. Refer to the refunding policy to understand any conditions that apply.
3. Next, complete the ‘Security Deposit’ field with the relevant amount, while also referencing the policy regarding the return of security deposits.
4. In the ‘Other Services Cost’ section, provide the necessary figures. You may need to consult the services table attached to the form for additional costs that may apply.
5. If applicable, fill in the ‘Private-Pay Residents Rate’ section to indicate the payment rate as determined by your situation.
6. For residents who are part of the Choices for Independence Waiver program, complete the relevant sections indicating your income documentation.
7. Document your ‘Personal Needs Allowance’ based on your specific calculations; consult your local Medicaid Office for assistance.
8. Proceed to the ‘Meals’ section and ensure the details about meal offerings and special dietary needs are completed accurately.
9. Fill out the ‘Services’ table by marking which services you require and whether they are included in the base rate or available at an extra cost.
10. Complete the ‘Staff Coverage’ section by providing the necessary details about staff availability at your facility.
11. Review all entries for accuracy and completeness before proceeding to the ‘Signatures’ section.
12. Finally, ensure that the prospective resident, legal representative, and facility staff sign the form. Ensure the dates are included.
13. After completing the form, you can save changes, download, print, or share it as necessary.

Complete your NH BEAS 3540 form online today to ensure a smooth process for your residential care requirements.