Get Demographic Form For Interim Icf/mr Level Of Care - Alaska ...

Filling out the Demographic Form for Interim ICF/MR Level of Care in Alaska is a vital process in providing essential information about a client's care needs. This guide offers step-by-step instructions to help you accurately complete the form online with confidence.

Follow the steps to successfully complete the Demographic Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin by entering the client's last name, first name, date of birth, Medicaid number, and Social Security number in the appropriate fields.
3. Next, provide the plan of care start date and the date the demographic form is submitted.
4. Answer the first question regarding the client's living situation at the time of the last ICAP, indicating if they were living in or discharged from an institution, correctional facility, or long-term care facility. Specify the name of the facility and the discharge date if applicable.
5. Input the primary diagnosis and any secondary diagnoses for the client, ensuring to be as precise as possible.
6. Respond to whether there have been significant changes in the client’s behavior or health over the last year. If so, specify these changes and attach any relevant supporting documentation.
7. Complete the primary physician information section by filling in the last name, first name, physical address, fax number, and phone number.
8. Fill out the care coordinator information, including their last name, first name, agency, phone, and email.
9. Review all completed fields for accuracy and completeness, ensuring you enter 'n/a' where applicable.
10. Once all information is filled out, prepare to save, download, print, or share the completed form as necessary.

Complete the Demographic Form online today to ensure precise and timely processing.