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HOME & COMMUNITY BASED CARE FOR THE ELDERLY/DISABLED AND DEVELOPMENTALLY DISABLED BILLING FORM 10397 2 1 M Billing Period: M Provider Number D / Provider Name (Last, First, MI) 4 3 North Dakota Department
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Step 1: Gather all necessary information and documents required for filling out the home and community-based form.
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Step 2: Start by providing personal details of the individual who needs home and community-based services, such as name, address, and contact information.
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Step 3: Specify the type of home and community-based services required, whether it's related to healthcare, counseling, or any other specific need.
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Step 4: Provide information about the medical history and current health condition of the individual, including any disabilities or illnesses that require special attention.
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Step 5: Detail the reason for seeking home and community-based services, explaining the individual's limitations or challenges that make such assistance necessary.
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Step 6: Include information about any current support systems or resources available to the individual, such as family members, home healthcare providers, or community organizations.
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Step 7: Attach any supporting documents or medical reports that may strengthen the application, providing a comprehensive understanding of the individual's needs.
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Step 8: Review the filled-out form for accuracy and completeness, ensuring all sections are properly filled and all necessary information is included.
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Step 9: Submit the filled-out home and community-based form to the designated authority or organization responsible for processing such applications.
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Step 10: Follow up with the concerned authority or organization to inquire about the status of the application and any additional steps that need to be taken.

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Any individual who requires additional support, medical assistance, or counseling while remaining in their home or community may benefit from home and community-based services.
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Individuals with disabilities or chronic illnesses that limit their ability to perform daily activities may require home and community-based assistance.
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Elderly individuals who prefer to receive care and support in their familiar environment rather than moving to a nursing home or assisted living facility can benefit from these services.
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Family caregivers who need respite or relief from their caregiving duties can opt for home and community-based services to ensure their loved ones receive proper care.
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Individuals facing temporary or long-term challenges that prevent them from fully participating in community activities can find support through these services.
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Those seeking specialized healthcare or counseling services in a home or community setting can also benefit from home and community-based options.
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Home and community-based services provide support and assistance to individuals in their homes or communities, allowing them to remain independent.
Individuals or organizations providing home and community-based services are required to file.
To fill out home and community-based forms, providers must enter accurate information about the services they provide and the individuals they serve.
The purpose of home and community-based services is to help individuals live independently and access necessary supports.
Providers must report information such as the types of services provided, the number of individuals served, and any outcomes achieved.
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North_Dakota thereunder false SEQ SFN forproviding USC promulgated DEVELOPMENTALLY foregoing applicable Providers Certification herein certify affiliation concealment Billed specified correcting furnish Recipient furnished Provider prosecuted disclose

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