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  • Mi Dhs-1643 2021

Get Mi Dhs-1643 2021-2025

Hild Welfare staff) Child/Youth Name Date of Birth Medicaid ID # MiSACWIS Person ID # Legal Status Current Placement Date Placement Type Authorized Consenter(s) Relationship to Child/ Youth Contact Phone Caseworker Caseworker Phone Agency SECTION B HEALTH INFORMATION (Completed by medical provider or medical staff) Physician Name Phone Appointment Date Location of Appointment Witnessed Verbal Consent Identification Number (Completed by PMOU) Mental Health Diagnoses SECTION C.

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Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a treatment. The patient must be competent to make a voluntary decision about the treatment. Written informed consent is required for the use of psychotropic medications.

Using the Change Report Form You may use the DHS-2240, Change Report Form, to report changes to your specialist. If you choose this method you must answer all questions on the form for everyone in your household. If any questions do not apply to your household situation, answer the question N/A, not applicable.

Call the Secretary of State Information Center with questions about your driver's license, state ID, vehicle registration or license plate at (888) 767-6424.

Michigan Department of Health & Human Services 517-335-8951 (phone) 517-335-8835 (fax) 1-800-942-1636 (toll-free) 517-335-8951 (voc)

You can contact Provider Support at any point if you need help by phone 1-800-979-4662 or email providersupport@Michigan.gov. 4. How do I get an Adult Service Worker? Call the local Department of Health and Human Services county office and ask for the Adult Services Unit.

1-888-678-8914 This number is also located on the back of your Michigan WIC Bridge Card. You can call this number, free of charge, 24 hours a day, 7 days a week.

You can find your caseworker's specialist ID on the top right corner of a notice you received from the Michigan Department of Health and Human Services (MDHHS). The specialist ID is usually a combination of the specialist's name.

If you can't reach your worker directly, you can try contacting your local MDHHS office . You can also try calling the main MDHHS phone line at (517) 241-3740. If you are using the MI Bridges website to apply for or manage benefits, you can try calling the MI Bridges help desk at (844) 799-9876.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232