This form is a questionaire to be provided to all new clients to assist the attorney in gathering information regarding the client and his or her claim.
Arkansas New Client Questionnaire
State:
Multi-State
Control #:
US-PI-0232
Format:
Word;
Rich Text
Instant download
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 or toll free at (800) 457-4454. When prompted, select 0 for ?Other Inquiries?, then option 3 for ?Provider Enrollment?.
The DCO-702 is used by facilities to report to the DHS county office all Medicaid-related admissions, discharges, and transfers.
Arkansas Medicaid requires that some surgical procedures be authorized by AFMC prior to the performance of the procedure.
*Please note that there is a 60-month look-back period from the date of one's Medicaid application to ensure assets were not gifted or sold for less than they are worth. If one is found to have violated the look-back period, one may be penalized with a period of Medicaid ineligibility.
How to Upload Documents? Once you have logged in to your Access Arkansas account, click on ?Details? for the case you want to upload the document for. If you don't see the case, please see section ?How to Link Your Case? for more details. On the right-hand side of the screen click on ?Upload files.?
016-20-99 Ark. Code R. § 18 Form DCO-116, Client Statement Regarding Absent Parent, is used to collect information from the Medicaid client about an absent parent. The DCO-116 is an optional form to be used when securing absent parent information through the mail.
Who is eligible for Arkansas Medicaid Program? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows
If you have any questions about the updated Access.Arkansas.gov when you start using, you can: Call our support line at 1-855-372-1084. Call or visit your local county office | Find your county office.
Call the Renew Arkansas hotline at 1-844-872-2660. Go online at access.arkansas.gov. Visit your local DHS county office to update your information (find your local office here)
