We're Hennepin Health | Hennepin Health

IS MEMBER RECEIVING ARMHS SERVICES FROM MORE THAN ONE PROVIDER? LIST ALL OTHER PROVIDERS( i.e.: Home health agencies, CSP etc): _____ _____ IRTS Extension: List the reasons why the member requires an IRTS level of care beyond 90 days (HENNEPIN HEALTH to be notified prior to completion of 90 days): _____ ................
................