WebSep 28, 2024 · The Level of Care Determination (LOCD) is the process the Michigan Medicaid ... a "Request for an Administrative Hearing" form (DCH-0092) to: MICHIGAN ADMINISTRATIVE HEARING SYSTEM FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 30763 LANSING, MI 48909 Fax the form to: 517-763-0146 WebOct 1, 2003 · The OBRA Level I screening: ·. Identifies if a person has a diagnosis or suspected diagnosis of developmental disabilities or related conditions. ·. Identifies if a person has a mental illness or symptoms of a mental illness. ·. Refers the person for an OBRA Level II evaluative report, if necessary. For more information, see CBSM – OBRA ...
DHS-3471, DHS/SSA Referral - DocsBay
WebHawaii Level of Care Forms and Resources. Click the links below to access and print the most-current evaluation forms and instructions approved by the Med-QUEST Division: DHS/MQD Form 1147 (Revised 1/1/21) DHS/MQD Form 1147 Instructions (Revised 1/1/2024) DHS/MQD Form 1147a (Revised 1/1/2024) WebDHS-1945 (Rev. 8-11) Previous edition obsolete. MS Word 2 Section II – If any 1 characteristic or care need is checked in Section 2A the youth qualifies for Level II DOC. • If any two items are checked in Section 2B or 2C the youth qualifies for a level II DOC. • If only 1 item in section 2B or 2C is checked and none in section 2A the youth qualifies for … how does the seasons affect the climate
Level of Care Assessment Tool Instructions - dhs.state.or.us
http://198.109.89.71/forms/forms_files/MDHHS/13-MDHHS-3471.pdf Webthe Level of Care Assessment section of this form and meets all financial eligibility criteria. This will be verified by having one area in the Level of Care Assessment section rated a … Webindividual is recommended for ICF/ID level of care or an MA 51 form completed by a licensed physician, physician's assistant, or certified registered nurse practitioner may be submitted to document that the individual is recommended for an ICF/ID level of care. Documentation of the results of both the standardized general intelligence test and the photofort studios