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FAMILY CARE PARTNERSHIP Community Care Family Care Partnership Program Family Care Partnership Member Handbook FOR PEOPLE ENROLLED IN MEDICAID ONLY C A LU M ET, K E N OS H A, M I LUAU K EE, OF TAG
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How to fill out the family care partnership member:

01
Obtain a copy of the family care partnership member form from the designated organization or agency.
02
Carefully read through the instructions provided with the form to understand the requirements and necessary information.
03
Begin by entering personal details such as your full name, date of birth, contact information, and address in the designated fields.
04
Provide any relevant identification numbers, such as your Social Security number or driver's license number, if required.
05
Specify your relationship to the person in need of care, such as parent, sibling, or spouse.
06
Include details about the specific care needs of the individual, including any medical conditions, disabilities, or special requirements.
07
Indicate any existing healthcare providers or facilities involved in the individual's care, including their contact information and addresses.
08
If applicable, provide information about sources of income, insurance coverage, or government assistance programs that the individual receives.
09
Sign and date the form to certify the accuracy of the provided information.
10
Submit the completed form to the designated organization or agency, following any additional instructions or requirements.

Who needs family care partnership member?

01
Individuals who require assistance with daily living activities or have medical or disability-related needs that cannot be managed independently.
02
Family members or individuals responsible for coordinating the care and well-being of the individual in need.
03
Caregivers or healthcare professionals who work closely with the individual and need access to their medical history or care plans.
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Family care partnership member is a member of a family care partnership who receives benefits and services from the partnership.
The individual or family who is part of the family care partnership is required to file the family care partnership member.
To fill out the family care partnership member, you need to provide personal information, details of benefits received, and services utilized from the partnership.
The purpose of the family care partnership member is to track the benefits and services provided to members of the partnership.
The information that must be reported on the family care partnership member includes personal details, benefits received, and services utilized within the partnership.
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