Get Dhhs Form 3291

Filling out the Dhhs Form 3291 is an essential step for individuals seeking Medicaid eligibility under the TEFRA program. This guide will provide you with a clear, step-by-step process to complete the form online, ensuring that all necessary details are accurately captured.

Follow the steps to complete the Dhhs Form 3291 online effectively.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. In the section named 'To:', enter the name of the Medicaid eligibility worker who will receive this certification. Ensure the spelling is correct to avoid any delays in processing your application.
3. In the 'From:' section, input the name of the physician completing the form. This must be a licensed medical doctor (M.D.) who has been involved in the applicant's care.
4. Enter the date on which the form is completed. This information helps establish the timeliness of the certification.
5. The section labeled 'Child’s full name' requires the full legal name of the applicant for whom the care at home is being certified. Ensure this is accurate, as it will be crucial for identification purposes.
6. The physician must provide their signature in the designated area to validate the certification. This signifies their agreement that home care is appropriate for the applicant.
7. Complete the physician’s address information, including city, state, zip code, and area code/telephone number. This ensures that the Medicaid eligibility worker can reach out if further information is needed.
8. After filling out all sections accurately, review the form for any errors or omissions. It is important that all information is correct before submission.
9. Save any changes made to the form. Depending on your needs, you may choose to download, print, or share the completed form with relevant parties.

Complete the Dhhs Form 3291 online today to ensure timely processing of your Medicaid eligibility.