HI DHS 1108 2009-2025 free printable template

Name: Dhs Form 1108 Oahu - Fill Online, Printable, Fillable, Blank | pdfFiller
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State of Hawaii Department of Human Services Med-QUEST Division Date Received by DHS OFFICIAL USE ONLY Organization Assisting with Application Case Name Case Number Worker's Name Section/Unit/EW Code

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How to fill out HI DHS 1108

01

Obtain the HI DHS 1108 form from the Hawaii Department of Human Services website or local office.

02

Read the instructions carefully to understand what information is required.

03

Fill in your personal details such as name, address, and contact information in the designated sections.

04

Complete any required income information, including sources and amounts.

05

Provide details regarding your household composition, including names and relationships of household members.

06

Review the form for accuracy and completeness before submission.

07

Sign and date the form at the indicated section.

08

Submit the completed form to the appropriate address as indicated in the instructions.

Who needs HI DHS 1108?

01

Individuals or families applying for assistance programs within Hawaii.

02

Residents seeking to report changes in their household or income.

03

People applying for services such as food assistance, medical benefits, or public assistance.

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What is HI DHS 1108?

HI DHS 1108 is a form used for reporting specific health information and data required by the Department of Health Services (DHS).

Who is required to file HI DHS 1108?

Entities such as healthcare providers, facilities, and organizations that fall under the jurisdiction of the Hawaii Department of Health and who are required to report health data must file HI DHS 1108.

How to fill out HI DHS 1108?

To fill out HI DHS 1108, obtain the form, provide the required information accurately in the designated fields, and follow the instructions for submission, which may include electronic or paper filing as specified by DHS.

What is the purpose of HI DHS 1108?

The purpose of HI DHS 1108 is to collect health-related data to monitor public health trends, ensure compliance with health regulations, and inform health policy decisions.

What information must be reported on HI DHS 1108?

The information that must be reported on HI DHS 1108 typically includes patient demographics, health service utilization data, and other relevant health metrics as required by the DHS.

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