Get Wa Dshs 14-300 2017

The WA DSHS 14-300 form is crucial for the pre-admission screening of individuals considered for admission into Medicaid-certified nursing facilities. This guide offers clear, step-by-step instructions on how to complete this online form effectively.

Follow the steps to complete the WA DSHS 14-300 form online.

1. Press the ‘Get Form’ button to obtain the WA DSHS 14-300 form and open it in your editor.
2. Begin by entering the name of the individual being screened and their ADSA ID if available. You will also need to provide the date of birth in the format MM/DD/YYYY.
3. Next, fill out the legal representative or necessary supplemental accommodation (NSA) information, including facility name and relationship. If NSA is applicable, ensure you provide the NSA phone number.
4. Complete the facility address information by populating the address lines and relevant details to ensure accurate identification of the nursing facility.
5. In Section I, indicate if the individual has signs of serious mental illness or an intellectual disability by marking 'Yes' or 'No' for each indicator. Include DSM codes if known.
6. Proceed to Section II where you will check off if any conditions for exempted hospital discharge apply in addition to providing categorical determinations if relevant.
7. In Section III, document the basis for any exempted hospital discharge or categorical determination and ensure that appropriate signatures are obtained, including the name and title of the person completing the form.
8. Lastly, review all entries for accuracy, then proceed to save changes, download the form, or print it for distribution or sharing as needed.

Complete your WA DSHS 14-300 form online today to ensure a smooth admission process.