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ALTOS ETC Form Sending PC:Receiving PC:Transition Date:Rate Code:Primary Language Spoken’M or Contact Person / Relationship:(Indicate if Guardian, POA, etc.) Contact Person Phone #:Primary Health
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Altcs eti form is the Eligibility Determination Form used by the Arizona Long Term Care System (ALTCS) to assess an individual's eligibility for long-term care services.
Individuals who are seeking long-term care services and wish to apply for ALTCS eligibility are required to file the Altcs eti form.
The Altcs eti form can be filled out by providing personal and financial information as requested on the form. It is recommended to seek assistance from a case manager or ALTCS representative if needed.
The purpose of Altcs eti form is to determine an individual's eligibility for long-term care services covered by the Arizona Long Term Care System.
The Altcs eti form requires information such as personal details, income, assets, medical history, and other relevant information to assess eligibility for long-term care services.
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