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Addictive and Mental Disorders Division (ADD) Severe and Disabling Mental Illness (SEMI) Home and Community Based Services (HUBS) Waiver Clinical SEMI Eligibility Request All forms must be typed.

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What is dementia stipulation form?

Dementia stipulation form is a legal document that outlines the wishes and preferences of an individual with dementia regarding their care and treatment.

Who is required to file dementia stipulation form?

The individual with dementia or their legal guardian is required to file the dementia stipulation form.

How to fill out dementia stipulation form?

To fill out the dementia stipulation form, the individual or their legal guardian must provide detailed information about their preferences for care, treatment, and end-of-life decisions.

What is the purpose of dementia stipulation form?

The purpose of the dementia stipulation form is to ensure that the wishes of the individual with dementia are respected and followed in the event that they are no longer able to make decisions for themselves.

What information must be reported on dementia stipulation form?

The dementia stipulation form must include information about the individual's medical history, treatment preferences, end-of-life care preferences, and legal designation of a healthcare proxy.

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