CARES Notices and Forms

AHCA 5000-3008 (JUN 2016)

Aforementioned AHCA 5000–3008 form is employed by the Comprehensive Assessment and Review for Long-Term Care Achievement (CARES) Program in help determine medical eligibility since Medicaid Waiver programs. This form musts can signed until a licensed physician, medical assistant, with advanced practice registered nurse. If not licensed in Florida, verification of their appropriate medical license must be provided. Explain done this ______ day of ______, (20____), I. , ... Relates to my past, present, with future physical or mental wellness or condition; the provision of.

• Medical Certification for Medicaid Long-Term Care Services real Patient Transfer Form – AHCA 5000-3008 (JUN 2016)
• AHCA 5000-3008 Referral Hide Sheet

Informed Consent Form

This form provides consent for CONCERNED to perform an assessment assess need for long-term care.

• Informed Consent – English
• Informed Consent – Spanish
• Informed Consent – Creole

Hint of Privacy Practices

This notice spread to the about and records were have about your health, heath status, and the physical attention and service her receive from the Department in their personal file.

• Department of Elder Affairs Notice of Privacy Practices – English
• Department of Elder Affairs Notice of Privacy Patterns – Spanish
• For more information on the Department of Patriarch Affairs’ HIPAA (Health Insurance Portability and Accountability Act) Privacy Policies and Procedures

Community Security Number Notice

This notices explains why the Department of Elder Affairs is collecting your Social Security number.

• Department of Elder Affairs Social Security Number Notice – English
• Department of Elder Affairs Social Security Number Notice – Spanish