ADHC Participant Initial Assessment Report - Cover Sheet
ADULT DAY HEALTH CARE CENTERPARTICIPANT INITIAL ASSESSMENT REPORTCOVER SHEETInstructions to ADHC Centers: Complete this form and attach it to completed Initial Assessment Reports before forwarding them to the Long-Term Care Division. Date:From:To:Department of Health Care ServicesLong-Term Care Division1501 Capitol Ave., MS 0018PO Box 997413Sacramento, CA 95899-7413Please review the enclosed Initial Assessment Report(s) for the following ADHC participant(s) to determine potential eligibility for the In-Home Operations Waiver (rows will expand to accommodate more than one participant name).ADHC Participant(s):Date(s) of Birth:Medi-Cal Client ID Number(s):Please direct questions to:ADHC Contact:Phone:E-mail:Questions about the In-Home Operations Waiver may be directed to the Long-Term Care Division In-Home Operations Branch at (916) 552-9105, or IHOWAIVER@dhcs.. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- special education assessment report tem
- initial psychiatric assessment pdf
- nist risk assessment report template
- psychological assessment report template
- initial assessment form for counseling
- apa psychological assessment report template
- nist security assessment report template
- assessment report template word
- budget cover sheet example
- proposal cover sheet template
- assessment report format
- assessment report outline