Get Hi Dhs 1178 2013-2026

The HI DHS 1178 form is a critical document used for the preadmission screening and resident review process in Hawaii. This guide provides a detailed walkthrough for completing the form online, ensuring a smooth application experience for users.

Follow the steps to successfully complete the HI DHS 1178 online.

1. Press the ‘Get Form’ button to obtain the HI DHS 1178 and open it in your editing tool.
2. Begin by filling in the patient’s name in the designated field, using the format Last Name, First Name, M.I.
3. Input the date of birth in the mm/dd/yy format to ensure accurate record-keeping.
4. Enter the social security number in the appropriate field.
5. Provide the Medicaid I.D. number if applicable, ensuring all numbers are accurate.
6. Identify the referral source, which may include options such as the physician's name, nursing facility, or hospital.
7. Proceed to Part A, where you will assess the criteria for serious mental illness (SMI). Carefully choose 'Yes' or 'No' for each question based on the patient's current mental health diagnosis.
8. In Part B, address the presence of developmental disability/intellectual disability (DD/ID) using 'Yes' or 'No' responses, following the instructions provided.
9. Move to Part C to evaluate any additional conditions that may apply to the individual, marking 'Yes' or 'No' for each item listed.
10. At the end of the form, review all responses for accuracy, then sign and date it as required.
11. Finally, you can save your changes, download, print, or share the completed form for submission.

Complete the HI DHS 1178 online today for an efficient submission process.