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Addendum Cover Page for Maryland Medical Assistance Program Application FACILITY/ORGANIZATION PT 54 IMD RESIDENTIAL SUD ADULT If you have questions, please contact the Provider Enrollment Helpline
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01
Start by entering the date of filling out the PT54 IMD Residential form at the top.
02
Provide the patient's full name, date of birth, gender, and contact information.
03
Fill in the patient's current residential address.
04
Indicate whether the patient is the owner, tenant, or occupant of the residence.
05
If the patient is a tenant or occupant, provide the name and contact information of the landlord or owner.
06
Specify the number of people living in the same residence as the patient.
07
Provide information about any changes in the residential address during the past year.
08
If the patient receives support or assistance in finding housing, provide details of the support received.
09
Indicate any current issues or concerns related to the patient's residential situation.
10
Sign and date the form to complete the process of filling out PT54 IMD Residential.

Who needs pt 54 imd residential?

01
PT54 IMD Residential form is needed by individuals seeking mental health services in residential settings, including IMD (Institution for Mental Disease) facilities.
02
This form is typically required for admission or assessment purposes and is used to gather information about the patient's current residential situation.
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PT 54 IMD Residential is a tax form used to report income and deductions related to residential properties for taxpayers in specific jurisdictions.
Individuals or entities that own residential properties and have income that falls under the reporting criteria are required to file PT 54 IMD Residential.
To fill out PT 54 IMD Residential, one must provide detailed information regarding the residential property, including income, expenses, and relevant personal information as per the guidelines provided by the taxing authority.
The purpose of PT 54 IMD Residential is to ensure proper reporting of income and deductions for residential properties, which helps in accurate tax assessments.
Information that must be reported includes property details, rental income earned, expenses incurred, and the taxpayer's identification information.
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