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MnCHOICES Assessment Referral Form PLEASE PRINT! Complete referral form, save, and send as an attachment to Long Term Services and Supports Intake at: RSSSLTSSIntake@anokacountymn.gov or via fax at:

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How to fill out county mnchoices assessment referral

01

Gather necessary information about the individual needing the assessment.

02

Complete the referral form with accurate details including name, address, and contact information.

03

Include relevant medical history and current health status.

04

Specify the reason for the referral, including any specific concerns or needs.

05

Submit the completed form to the appropriate county office or designated authority.

06

Follow up to confirm receipt and to inquire about the next steps in the assessment process.

Who needs county mnchoices assessment referral?

01

Individuals seeking services or support related to disability, mental health, or long-term care in Minnesota.

02

Caregivers or family members concerned about the well-being of an individual requiring assessment.

03

Healthcare professionals recommending an assessment for their patients.

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What is county mnchoices assessment referral?

The county MNChoices assessment referral is a process used by Minnesota counties to assess individuals who may need assistance with long-term care services and supports.

Who is required to file county mnchoices assessment referral?

Individuals who are seeking long-term care services, their caregivers, or professionals involved in their care may be required to file a county MNChoices assessment referral.

How to fill out county mnchoices assessment referral?

To fill out the county MNChoices assessment referral, complete the designated referral form, providing all required information accurately, and submit it to the appropriate county department.

What is the purpose of county mnchoices assessment referral?

The purpose of the county MNChoices assessment referral is to determine eligibility for various long-term care services and to connect individuals with necessary resources and supports.

What information must be reported on county mnchoices assessment referral?

The referral must include personal information such as the individual's name, date of birth, contact details, as well as information regarding their care needs and any relevant medical history.

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