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COMMUNITY CARE ONLY Date RCD by CCB: Date RCD by CM: Date of Verbal Auth: Or Date of Denial Authorization #: Date of Auth Entry: Auth Entered By: BHR Service Requested (Select One): Initial POC Carbon/Monroe/Pike
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How to fill out community care only:

01
Start by gathering all the necessary information and documents required for the application. This may include personal identification, proof of residency, income verification, and any relevant medical records or documentation.
02
Begin the application process by locating the appropriate forms or online portal. These can typically be found on the website of the organization or agency responsible for community care services.
03
Carefully read through the instructions provided on the application form to ensure you understand the information being requested and any specific requirements or guidelines.
04
Fill out the application form accurately and completely. Provide all requested information, such as your name, address, contact details, and any relevant medical or caregiving history.
05
If there are any sections on the application that are unclear or require further explanation, don't hesitate to reach out to the agency or organization overseeing community care services for clarification.
06
Double-check the completed application form for any errors or missing information. It is important to ensure all details are correct and complete before submitting the application.
07
Once the application is filled out, review any additional supporting documents or evidence that may be required. Attach these alongside the application form, making sure to follow any specified instructions for document submission.
08
Submit the completed application and supporting documents as per the instructions provided. This may involve mailing a physical application packet, uploading documents online, or submitting in person at a designated location.

Who needs community care only:

01
Individuals who require assistance with daily activities due to physical or mental health conditions may benefit from community care services. This could include seniors, individuals with disabilities, or those recovering from an illness or injury.
02
Family members or caregivers of individuals who need additional support and respite may also seek community care services. These services can provide temporary relief and assistance to caregivers, enabling them to take breaks and attend to their own needs.
03
People who need specialized medical care or assistance with medication management may seek community care services. This can include individuals with chronic illnesses, complex medical conditions, or those in need of regular monitoring and medication administration.
04
Individuals who may be feeling isolated or lonely can benefit from community care services that offer companionship and socialization opportunities. This can help improve mental well-being and provide a sense of belonging within the community.
05
Community care services may also be accessed by individuals who require assistance with household tasks, such as cleaning, cooking, or transportation to appointments. This can help promote independence and maintain a safe and comfortable living environment.
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Community care only refers to the type of care provided to individuals within their own community, rather than in a formal institutional setting.
Individuals or organizations providing community care services are required to file community care only.
Community care only forms can usually be filled out online or in paper format, with details of the care services provided.
The purpose of community care only is to ensure that individuals in need of care and support can receive services within their own community.
Information on the type of care services provided, the recipients of the care, and any relevant details about the care providers must be reported on community care only.
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