MI DHS-54A 2008 free printable template
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Case Name MEDICAL NEEDS Michigan Department of Health and Human Services Case Number Recipient ID Number Patient s Name INSTRUCTIONS To be completed annually by a physician nurse practitioner physical or occupation therapist. Please County print or type. Patient s Birth Date District Section Specialist Unit Specialist Phone Number Medical Provider We would appreciate your cooperation in completing the spaces checked below. In addition to a physician Box A may be completed by a physician s...
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How to fill out MI DHS-54A
How to fill out MI DHS-54A
01
Gather required personal information, including your name, address, and Social Security number.
02
Complete section 1 with your demographic information.
03
Provide information about your household members in section 2.
04
Fill out section 3 with details regarding your income sources.
05
Complete section 4 about any assets you may have.
06
Answer the questions in section 5 related to your health and disability status.
07
Review the form for completeness and accuracy.
08
Sign and date the form in the designated section.
Who needs MI DHS-54A?
01
Individuals applying for assistance programs through the Michigan Department of Health and Human Services.
02
Persons with disabilities seeking support or benefits.
03
Households needing aid for financial support.
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People Also Ask about
Who oversees Michigan DHS?
Elizabeth Hertel, Director Elizabeth Hertel is the Director of the Michigan Department of Health and Human Services (MDHHS).
How do I contact DHS worker in michigan?
General Contact Information 517-335-8448 (phone) 517-335-8835 (fax) 1-800-942-1636 (toll-free) 517-335-8951 (voc)
How do I talk to a michigan EBT representative?
Michigan State SNAP Website. 1-888-642-7434. State List of Local Office Locations. Benefit Issuance Schedule.
How do I speak to someone at DHS Michigan?
If you suspect abuse or neglect, call 855-444-3911 any time day or night. This toll-free phone number allows you to report abuse or neglect of any child or adult.
What does DHS do in Michigan?
Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. Information on the Food Assistance Program, eligibility requirements, and other food resources. Health Care Coverage information and resources.
What is the number for DHS 844 in Michigan?
Contact Your Local Office or MDHHS Customer Service If you are using the MI Bridges website to apply for or manage benefits, you can try calling the MI Bridges help desk at (844) 799-9876.
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What is MI DHS-54A?
MI DHS-54A is a form used by the Michigan Department of Health and Human Services to report certain health-related information and data.
Who is required to file MI DHS-54A?
Entities or individuals involved in specific health service programs or operations as mandated by the state may be required to file MI DHS-54A.
How to fill out MI DHS-54A?
To fill out MI DHS-54A, follow the instructions provided on the form itself, ensuring all sections are completed with accurate and required information.
What is the purpose of MI DHS-54A?
The purpose of MI DHS-54A is to collect important health data for the state to monitor, evaluate, and improve public health initiatives and services.
What information must be reported on MI DHS-54A?
Information that must be reported on MI DHS-54A includes health service outcomes, demographic data, and any other relevant information as specified by the form's guidelines.
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