DHS Form 1147 Care Evaluation Instructions
This document provides detailed instructions for filling out the DHS Form 1147, used for Level of Care and At Risk evaluation. It includes step-by-step guidance on the necessary information and processes required for proper submission. Ideal for patients, caregivers, and healthcare professionals seeking to understand their responsibilities regarding this form.
Edit, Download, and Sign the DHS Form 1147 Care Evaluation Instructions
Form
eSign
Add Annotation
Share Form
How do I fill this out?
Filling out this form is essential to ensure accurate processing of care evaluations. Start by carefully reviewing each section and collecting necessary information about the patient. Follow the instructions step by step to avoid any omissions that could delay processing.
How to fill out the DHS Form 1147 Care Evaluation Instructions?
1
Review the evaluation request type and patient information.
2
Fill in patient address, Medicare, Medicaid details as applicable.
3
Complete the assessment information, ensuring accuracy.
4
Check the request type and enter relevant dates and approvals.
5
Submit the form to the designated service coordinator.
Who needs the DHS Form 1147 Care Evaluation Instructions?
1
Patients applying for Level of Care evaluations.
2
Healthcare providers needing to assess a patient's eligibility.
3
Family members supporting a relative's care evaluation.
4
Care coordinators assisting patients with their applications.
5
Social workers managing care assessments for clients.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the DHS Form 1147 Care Evaluation Instructions along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your DHS Form 1147 Care Evaluation Instructions online.
Edit your PDF effortlessly using our intuitive tools designed for easy modifications. You can adjust text, add notes, and navigate through sections seamlessly. Simply save your edited file once you finish making changes.
Add your legally-binding signature.
Signing your PDF is simple with our integrated tools that allow for electronic signatures. Just select the signature option, draw or upload your signature, and place it accordingly. Your signed document will be ready for submission in just a few clicks.
Share your form instantly.
Easily share your PDF directly from our platform with just a few steps. You can generate a shareable link or send it via email to the relevant parties. Collaborative options ensure everyone stays informed and up-to-date.
How do I edit the DHS Form 1147 Care Evaluation Instructions online?
Edit your PDF effortlessly using our intuitive tools designed for easy modifications. You can adjust text, add notes, and navigate through sections seamlessly. Simply save your edited file once you finish making changes.
1
Open the PDF document in our editor.
2
Select the text or section you want to change.
3
Make your edits using the text tools provided.
4
Save your changes after editing.
5
Download or share your edited document.
What are the instructions for submitting this form?
To submit the DHS Form 1147, ensure all fields are accurately filled out. You can send it via fax to the appropriate healthcare service coordinator, or email a scanned copy. All submissions should include the necessary patient information and be sent to specified healthcare addresses for timely processing.
What are the important dates for this form in 2024 and 2025?
Important dates for submission and processing of the DHS Form 1147 in 2024 and 2025 will align with annual reviews and operational deadlines set by healthcare management authorities. Ensure to check for updates regarding significant revisions related to eligibility assessments and changes in Medicaid. Keeping track of these dates helps avoid disruption in care evaluations.
What is the purpose of this form?
The DHS Form 1147 is designed to assess a patient's Level of Care and At Risk evaluation effectively. It serves as a comprehensive tool for healthcare providers to document patient information essential for determining eligibility for various services. Understanding the form's purpose aids in ensuring all necessary details are accurately provided to facilitate timely evaluations and necessary approvals.
Tell me about this form and its components and fields line-by-line.
- 1. Evaluation Request Type: Select initial, annual, or other evaluation request types as applicable.
- 2. Patient Name: Enter the full name of the patient.
- 3. Birthdate: Provide the patient's birthdate.
- 4. Gender: Indicate the patient's gender.
- 5. Medicare Info: Check and provide Medicare information.
- 6. Medicaid Eligibility: State whether the patient is Medicaid eligible.
- 7. Present Address: Provide the current address of the patient.
- 8. Attending Physician: Enter the name and contact info of the attending physician.
- 9. Referral Sources: Document referral information sources.
- 10. Assessment Information: Detail the assessment date and assessor's info.
What happens if I fail to submit this form?
Failing to submit this form may lead to delays in receiving necessary care services. Patients may miss out on critical evaluations needed for their health management. It's crucial to ensure all details are filled accurately to avoid complications.
- Delayed Care Services: Without submission, care services may be postponed, affecting patient health.
- Incomplete Evaluation: Failure to provide required information may result in incomplete evaluations.
- Withdrawal of Benefits: In some cases, lack of submission could lead to loss of benefits or eligibility.
How do I know when to use this form?
- 1. Initial Evaluation: Use this form to request an initial assessment for care needs.
- 2. Annual Review: Submit during annual reviews to reassess patient needs.
- 3. Changes in Care Status: Utilize when there are significant changes in the patient's health.
Frequently Asked Questions
How do I download this PDF after editing?
Simply click the download button once you are satisfied with your edits, and the PDF will be saved to your device.
Can I edit this PDF on a mobile device?
Yes, our platform is mobile-friendly, allowing you to edit PDFs on smartphones and tablets.
Is it possible to merge this PDF with another document?
You can easily merge it by using our editor to upload additional PDFs, then combine them for a complete document.
How many times can I edit this PDF?
You can edit the PDF as many times as you need before downloading the final version.
Do I need to create an account to edit this PDF?
No account is required to edit and download your PDF. Simply access the editor and start working.
What formats can I share this PDF in?
You can share the PDF via email, link, or download it for printing.
Can I annotate the PDF while editing?
Yes, our editing tools include options for comments and annotations.
Is there a limit to the file size I can upload?
Currently, you can upload PDFs up to a reasonable size for editing purposes.
How will I know if my edits have been saved?
A confirmation message will appear indicating that your edits have been successfully saved.
What if I make a mistake while editing?
You can easily undo changes and revert to previous versions in our editor.
Related Documents - DHS Care Evaluation Form
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
