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DPHHSSLTC132 (Rev. 1/18)STATE OF MONTANA Department of Public Health and Human Services BIG SKY WAIVER ADULT RESIDENTIAL CARE CALCULATIONMember Name: Medicaid #: A Bed Facility Name: PCF B Bed AFH
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Begin by downloading the DPHHS-SLTC-132 form from the official website of the State of Montana.
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Read the instructions carefully to understand the purpose and requirements of the form.
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Start by providing your personal information, such as your name, address, and contact details.
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If applicable, provide the necessary information about your caregiver or representative.
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Fill in the sections regarding your medical condition, including details about your diagnosis, treatment, and medications.
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The DPHHS-SLTC-132 form of the State of Montana is required by individuals who need to apply for the State Long-Term Care services or programs.
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This may include individuals who require assistance with daily activities, such as bathing, dressing, and eating, due to physical or cognitive limitations.
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Applicants may also need to provide this form if they are seeking financial assistance for long-term care expenses.
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It is important to refer to the specific eligibility criteria and guidelines provided by the State of Montana to determine if you need to submit the DPHHS-SLTC-132 form.
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DPHHS-SLTC-132 is a form used in the state of Montana related to the provision of long-term care services and is typically submitted to the Department of Public Health and Human Services.
Individuals or organizations providing long-term care services in Montana are required to file the DPHHS-SLTC-132 form.
To fill out the DPHHS-SLTC-132 form, carefully read the instructions provided with the form, complete each section as required, and provide accurate and up-to-date information.
The purpose of the DPHHS-SLTC-132 form is to collect necessary information from long-term care providers to ensure compliance with state regulations and to monitor the quality of care provided.
Information that must be reported includes details about the service provider, types of services offered, client demographics, and other relevant operational data.
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