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KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES TARGETED CASE MANAGEMENT TCM -FE PROVIDER CHOICE FORM For a list of case management providers in your area contact Kansas Department for Aging and Disability Services at 1-800-432-3535 or visit KDOA s website at www. kdads. ks. gov. Date Customer Name Beneficiary ID Number I understand that as a customer receiving Home and Community Based Services for the Frail Elderly I have the right to receive my Targeted Case Management services from the...
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How to fill out kdads provider choice form
01
To fill out the KDADS provider choice form, start by gathering all the necessary information. This includes the name of the individual who requires services, their contact information, and any supporting documentation that may be required.
02
Next, carefully read through the form and ensure that you understand all the questions and sections. Pay attention to any specific instructions or guidelines provided.
03
Begin filling out the form by providing the individual's personal information in the designated sections. This may include their full name, date of birth, address, phone number, and email address.
04
If applicable, indicate the specific services the individual requires and any preferences they may have regarding the provider or type of care.
05
In some cases, you may be required to provide information about the individual's medical history or any other relevant background information. Be sure to fill out these sections accurately and honestly.
06
If there are any additional documents or forms that need to be submitted along with the provider choice form, make sure to include them as instructed. This may include insurance information, identification documents, or medical records.
07
Once you have completed filling out the form, double-check all the information to ensure its accuracy. Making any necessary corrections or additions.
08
Finally, sign and date the form in the designated section. If you are filling out the form on behalf of someone else, indicate your relationship to the individual and include your own contact information if required.
Who needs the KDADS provider choice form?
The KDADS provider choice form is typically needed by individuals who require long-term services and supports through the Kansas Department for Aging and Disability Services (KDADS). This may include individuals with disabilities, older adults, or those in need of home- and community-based services.
The form allows individuals or their authorized representatives to choose the specific provider or agency they would like to receive services from. It provides an opportunity for individuals to have more control over their care and select a provider that best meets their needs and preferences.
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What is kdads provider choice form?
The kdads provider choice form is a form used by providers in the Kansas Department for Aging and Disability Services (KDADS) to indicate their choice of managed care organizations for their clients.
Who is required to file kdads provider choice form?
Providers in the Kansas Department for Aging and Disability Services (KDADS) are required to file the kdads provider choice form.
How to fill out kdads provider choice form?
To fill out the kdads provider choice form, providers need to state their choice of managed care organizations for their clients by filling in the necessary information in the form.
What is the purpose of kdads provider choice form?
The purpose of the kdads provider choice form is to allow providers in the Kansas Department for Aging and Disability Services (KDADS) to communicate their choice of managed care organizations for their clients.
What information must be reported on kdads provider choice form?
On the kdads provider choice form, providers must report their choice of managed care organizations for their clients.
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