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Get Pa Hcbs Form Pa 1768 2006
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How to fill out the PA HCBS Form PA 1768 online
Filling out the PA HCBS Form PA 1768 online is an essential step for users seeking Home and Community Based Services. This guide provides comprehensive instructions for completing the form digitally, ensuring you include all necessary information.
Follow the steps to complete the PA HCBS Form PA 1768 online
- Use the 'Get Form' button to obtain the form and access it in your preferred online environment.
- Begin by entering the office information, including the names of the District Office and the County Assistance Office, along with the date and the assessment agency conducting the evaluation.
- Provide the applicant or recipient demographic information. Include the first name, last name, address, city, state, zip code, date of birth, telephone number, social security number, and the name of the applicant’s representative if applicable.
- Indicate eligibility by checking the appropriate boxes to confirm whether the individual meets the level of care for Home and Community Based Services. Input dates for the assessment and when services will begin.
- For users who are new applicants or going through changes, transfers, or terminations, complete the relevant sections and add any necessary details on the reverse side of the form.
- Fill in agency information by providing the enrolling agency's contact person, telephone number, name, address, fax number, email, and any comments.
- Ensure to sign the form where indicated and provide the telephone number of the assessor.
- Once all sections are completed, save your changes, and choose to download, print, or share the form as needed.
Complete your PA HCBS Form PA 1768 online today to ensure timely processing of services.
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