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Get Hi Dhs 1147 2014-2025
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How to fill out the HI DHS 1147 online
The HI DHS 1147 form is essential for evaluating the level of care and at-risk determinations within the Hawaii Department of Human Services. This guide provides you with a clear, step-by-step approach to successfully complete and submit the form online.
Follow the steps to effectively complete your HI DHS 1147 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the identification section, where you will enter the patient’s name (last, first, middle initial), birthdate, and sex. Choose the appropriate request type: initial, annual review, reconsideration, or other review.
- Indicate whether the patient has Medicare coverage (Part A and/or Part B) by selecting ‘Yes’ or ‘No’ and provide the Medicare ID number if applicable.
- State whether the patient is Medicaid eligible by selecting 'Yes' or 'No' and provide the ID number or the date applied.
- Fill in the patient’s present address, indicating if they are at home, hospital, nursing facility, or another type of care home.
- Provide details about the attending physician or primary care provider including their name, phone number, and fax number.
- Specify the returning contact person, including their name and contact information, as well as any managed care plan details if applicable.
- The next section requires assessment information. Carefully fill in sources of information and the assessor’s details including their name and title.
- Select the type of care being requested from the provided options, and specify the requested length of approval.
- Complete any medical necessity determinations where applicable, ensuring that you review the guidelines provided carefully.
- Review all entered information for accuracy, and make any necessary corrections.
- Once complete, options to save changes, download, print, or share the completed form will be available.
Complete your HI DHS 1147 form online today to ensure timely processing of your request.
The year 1147 is notable in history for various events, including significant political shifts and battles. However, in the context of HI DHS 1147, this year does not bear direct relevance. Instead, focus on understanding how current laws and regulations, including HI DHS 1147, impact legal practices today.
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