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State of Alaska Department of Health and Social Services Senior and Disabilities ServicesPersonal Care Services Amendment to Service Plan Recipient name Medicaid numberAgency name Agency contact telephone
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Review the personal care services amendment form to understand the required information.
02
Fill in your personal information, such as name, address, and contact details.
03
Provide details about the amendment you are making, such as the reason for the amendment and any specific changes you want to make.
04
If there are any supporting documents or evidence that need to be attached, make sure to include them with the amendment form.
05
Double-check all the information you have entered to ensure accuracy and completeness.
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Sign and date the amendment form.
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Submit the completed amendment form and any required documents to the relevant authority or agency.

Who needs personal care services amendment?

01
Anyone who has previously applied for or is currently receiving personal care services may need to fill out a personal care services amendment. This includes individuals who need to update their personal information, make changes to their care plan, or report any changes in their circumstances that may affect their eligibility or the services they receive.
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A personal care services amendment is a form used to make changes to personal care services provided to individuals.
Providers of personal care services are required to file a personal care services amendment.
To fill out a personal care services amendment, providers must accurately report any changes to the services being provided.
The purpose of a personal care services amendment is to ensure that accurate information is reported regarding the care provided to individuals.
Providers must report any changes to the personal care services being provided, as well as any other pertinent information.
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