Get And Community-based Services Waivers - Cabinet For Health And ...

Filling out the And Community-Based Services Waivers form is a crucial step in accessing necessary services. This guide provides a clear, step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to retrieve the form and open it in your document editor.
2. Enter the name of the legal representative in the designated space. This should be the individual authorized to make decisions on behalf of the patient.
3. Provide the name and member number of the patient who is being represented. Ensure that the information is correct to avoid any processing delays.
4. Indicate the physical or mental incapacity of the patient, which authorizes the legal representative to execute the election of hospice benefits.
5. The legal representative must sign the form in the signature field to validate their authority.
6. Fill in the date of the signature to document when the form was signed.
7. A witness must also sign the form, followed by entering their date of signature.
8. Review all entered information for accuracy before finalizing. Then you can save changes, download, print, or share the completed form.

Start completing the And Community-Based Services Waivers form online today for prompt access to services.