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Applies to: ARC Tribal ADRSLongTerm Care Authorization, Enrollment, and Disenrollment Form Signatures Policy Last Revised: December 2022 This policy applies to Aging & Disability Resource Centers

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How to fill out adrc long-term care authorization

01

Obtain the ADRC Long-Term Care Authorization form from the appropriate agency or organization.

02

Fill out your personal information including name, address, phone number, and date of birth.

03

Provide information about your medical history and any current health concerns.

04

Specify any preferences or requirements you have for long-term care services.

05

Sign and date the form, acknowledging your understanding and agreement with the information provided.

Who needs adrc long-term care authorization?

01

Individuals who are seeking long-term care services and support through the ADRC (Aging and Disability Resource Center) will need to fill out the ADRC Long-Term Care Authorization form.

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What is adrc long-term care authorization?

ADRC long-term care authorization is a form that allows individuals to authorize the Aging and Disability Resource Center to provide long-term care services on their behalf.

Who is required to file adrc long-term care authorization?

Individuals who are in need of long-term care services and wish to have the Aging and Disability Resource Center provide these services on their behalf are required to file ADRC long-term care authorization.

How to fill out adrc long-term care authorization?

ADRC long-term care authorization can be filled out by providing personal information, medical history, and the specific long-term care services required. The form must be signed and dated by the individual or their legal representative.

What is the purpose of adrc long-term care authorization?

The purpose of ADRC long-term care authorization is to grant permission for the Aging and Disability Resource Center to provide necessary long-term care services to individuals in need.

What information must be reported on adrc long-term care authorization?

ADRC long-term care authorization must include personal information, medical history, details of required long-term care services, and the signature of the individual or their legal representative.

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