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SEMI HUBS 8996 DPHHSAMDD 055 (Rev. 02×14) STATE OF MONTANA Department of Public Health and Human Services ENTRANCE×DISCHARGE INTO MEDICAID HOME AND COMMUNITY BASED SERVICES APPLICANT: Name: (Last)
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How to fill out sdmi hcbs 899-6 entrancedischarge
How to Fill Out SDMI HCBS 899-6 Entrance/Discharge:
01
Obtain the SDMI HCBS 899-6 Entrance/Discharge form from the appropriate source.
02
Fill in the top section of the form with the individual's personal information, including their full name, date of birth, address, phone number, and any other required details.
03
Provide the reason for the individual's entrance or discharge from the SDMI HCBS program. This could be due to a change in their health status, a relocation, or any other relevant reason.
04
Indicate the date of entrance or discharge in the appropriate section of the form.
05
Specify the services that were provided during the individual's time in the SDMI HCBS program. Include details such as the types of services received, the frequency of these services, and any other relevant information.
06
If applicable, document any changes in the individual's health status or needs that occurred during their time in the program.
07
Sign and date the form, certifying the accuracy of the information provided.
08
Submit the completed SDMI HCBS 899-6 Entrance/Discharge form to the appropriate authority or organization.
Who Needs SDMI HCBS 899-6 Entrance/Discharge:
01
Individuals who are receiving or have received services through the SDMI HCBS program may need to complete the SDMI HCBS 899-6 Entrance/Discharge form.
02
This form is necessary for documenting and tracking the entrance and discharge of individuals from the program.
03
Providers, caregivers, or authorized individuals responsible for the individual's care and services may also need to fill out this form to ensure proper record-keeping and compliance with program regulations.
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What is sdmi hcbs 899-6 entrancedischarge?
sdmi hcbs 899-6 entrancedischarge is a form used to report the entrance and discharge of individuals in a specific healthcare program.
Who is required to file sdmi hcbs 899-6 entrancedischarge?
Healthcare providers and facilities are required to file sdmi hcbs 899-6 entrancedischarge.
How to fill out sdmi hcbs 899-6 entrancedischarge?
To fill out sdmi hcbs 899-6 entrancedischarge, one must provide detailed information about the individual's entrance and discharge from the healthcare program.
What is the purpose of sdmi hcbs 899-6 entrancedischarge?
The purpose of sdmi hcbs 899-6 entrancedischarge is to track and report the movement of individuals in healthcare programs for monitoring and billing purposes.
What information must be reported on sdmi hcbs 899-6 entrancedischarge?
Information such as the individual's name, date of entrance, date of discharge, reason for discharge, and any additional notes must be reported on sdmi hcbs 899-6 entrancedischarge.
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