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DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-11136 (10/08) STATE OF WISCONSIN HFS 107.13(2), Wis. Admin. Code FORWARDHEALTH PERSONAL CARE ADDENDUM Instructions:

How to fill out cms 485 form

How to fill out forwardhealth personal care addendum:

1. Obtain the forwardhealth personal care addendum form from the appropriate source.
2. Carefully read the instructions provided with the form to ensure understanding of the required information and any additional documentation needed.
3. Provide accurate personal information such as name, address, date of birth, and contact details in the designated fields.
4. Indicate the reason or purpose for filling out the addendum in the specified section.
5. Clearly disclose any relevant medical conditions, disabilities, or special needs that require personal care assistance.
6. Include details about the specific type of personal care needed, including assistance with activities of daily living or medical tasks.
7. If applicable, explain any additional information or circumstances that may be relevant to the personal care arrangement.
8. Review the completed form to ensure all information is accurate and legible.
9. Sign and date the addendum form where indicated.
10. Submit the completed forwardhealth personal care addendum form to the appropriate authority or agency.

Who needs forwardhealth personal care addendum:

1. Individuals who require personal care assistance due to medical conditions, disabilities, or special needs.
2. Caregivers or family members who provide personal care assistance and need to document the arrangement.
3. Health care professionals or agencies involved in providing personal care services who require an official addendum for record-keeping or legal purposes.

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What is forwardhealth personal care addendum?

ForwardHealth personal care addendum is a form that is required to be filed by certain healthcare providers to report additional information related to personal care services provided to Medicaid beneficiaries.

Who is required to file forwardhealth personal care addendum?

Healthcare providers who provide personal care services to Medicaid beneficiaries are required to file the forwardhealth personal care addendum.

How to fill out forwardhealth personal care addendum?

The forwardhealth personal care addendum form must be completed by entering the required information such as the provider's name, date of service, Medicaid ID of the beneficiary, and specific details about the personal care services provided.

What is the purpose of forwardhealth personal care addendum?

The purpose of the forwardhealth personal care addendum is to provide additional details about the personal care services provided to Medicaid beneficiaries for billing and reporting purposes.

What information must be reported on forwardhealth personal care addendum?

The forwardhealth personal care addendum requires reporting of information such as the provider's name, date of service, Medicaid ID of the beneficiary, and specific details about the personal care services provided.