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Mercy Maricopa Bridge to Permanency Application NO: Direct Care Clinic: Case manager (print name): Case manager email: Case manager phone: Indicate Housing Authority (select only one):Maricopa County
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How to fill out mercy maricopa bridge to

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To fill out the Mercy Maricopa Bridge To form, follow these steps:
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Start by downloading the form from the official Mercy Maricopa website.
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Read the instructions carefully to understand the purpose of the form and the information required.
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Begin by providing your personal details such as your name, address, contact information, and date of birth.
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Make sure to fill out all the required fields accurately and completely. Double-check for any errors or missing information.
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If you have any existing medical conditions or receive any form of behavioral health services, provide relevant details in the designated sections.
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If you are filling out the form on behalf of someone else, ensure to accurately provide their information and indicate your relationship to them.
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Review the completed form to ensure all information is accurate and up-to-date.
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Sign and date the form. If applicable, have the person for whom the form is being filled out also sign and date it.
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Make a photocopy of the completed form for your records before submitting it.
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Submit the form to the designated Mercy Maricopa office or follow the instructions provided on how to submit it electronically.
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Wait for confirmation of receipt or further instructions from Mercy Maricopa.
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Who needs mercy maricopa bridge to?

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Mercy Maricopa Bridge To is needed by individuals who require behavioral health services in Maricopa County, Arizona.
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It is specifically designed for individuals who have Medicaid or are eligible for Medicaid in Arizona.
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Mercy Maricopa Bridge is a program designed to help individuals transition between behavioral health and physical health services.
Providers and organizations participating in the Mercy Maricopa Integrated Care system are required to file Mercy Maricopa Bridge forms.
To fill out Mercy Maricopa Bridge forms, providers need to ensure all relevant information about the individual's transition between services is accurately documented.
The purpose of Mercy Maricopa Bridge is to ensure continuity of care and support for individuals transitioning between behavioral and physical health services.
Information such as the individual's current services, treatment plan, and any changes in health status must be reported on Mercy Maricopa Bridge forms.
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