Get Request For Exception From Waiver Requirement For Face-to-face ...

This guide provides a clear, step-by-step approach to completing the Request For Exception From Waiver Requirement For Face-to-Face Visits online. Users can navigate the form with confidence using this professional and supportive guide.

Follow the steps to complete your request form effectively.

1. Press the ‘Get Form’ button to access the form and open it in your preferred digital editor.
2. Begin by entering the recipient's legal name in the designated field marked 'Legal Name (Last, First)'. Ensure accuracy to prevent processing delays.
3. Input the CCAN number in the specified field. This number is important for identifying the recipient in the system.
4. Fill in the 'POC Start Date' and 'POC End Date' to indicate the time frame relevant to your request.
5. Provide the recipient's complete street address in the 'Recipient Street Address' field, along with the city, state, and zip code.
6. Enter the recipient’s telephone number to facilitate communication regarding the request.
7. Identify the care coordinator by entering their name in the 'Care Coordinator' field.
8. Input the care coordinator's number in the 'C.C. Number' section.
9. Provide the C.C. agency number and telephone number in their respective fields.
10. In the provided text box, clearly state your request for an exception to the requirement for monthly face-to-face visits, including justification related to the recipient's rural residence.
11. Acknowledge your understanding of the requirements and your commitment to the minimum visit schedule, and document the required signature of the care coordinator along with the date.
12. After completing the form, review your entries for accuracy, then save your changes, download, print, or share the completed document as necessary.

Complete your Request For Exception From Waiver Requirement For Face-to-Face Visits online today for timely processing.