Fill in Your Fhsc 18 Nevada Form Make My Form Online

Fill in Your Fhsc 18 Nevada Form

The Fhsc 18 Nevada form is a critical document used for the Level I Identification Screening in the Nevada Medicaid and Nevada Check Up Programs. This form helps assess individuals for mental illness, mental retardation, and related conditions, ensuring they receive appropriate care and services. Understanding the details and requirements of this form is essential for healthcare providers and legal representatives involved in patient care.

Make My Form Online

Key takeaways

Here are some important points to keep in mind when filling out and using the Fhsc 18 Nevada form:

  • Accurate Information is Key: Ensure that all personal details such as the patient’s name, Social Security number, and Medicaid billing number are filled out correctly. Mistakes can delay processing.
  • Confidentiality Matters: Remember that this form is confidential. Handle it with care and only share it with authorized personnel to protect the patient's privacy.
  • Complete All Sections: Fill out every section that applies to the patient. Incomplete forms may lead to complications or rejection of the application.
  • Follow Submission Guidelines: Submit the form via fax or phone as directed. Make sure to keep a copy for your records.
  • Seek Help if Needed: If you have questions while completing the form, don’t hesitate to reach out to the provided contact number for assistance.

Documents used along the form

The FHSC 18 Nevada form is a key document used in the assessment of individuals for Medicaid and Nevada Check Up Programs. Several other forms and documents often accompany this form to ensure comprehensive evaluation and compliance with regulations. Below is a list of these documents, along with brief descriptions of each.

  • Medicaid Application Form: This form is used to apply for Medicaid benefits. It collects personal information, financial details, and medical history to determine eligibility.
  • Level II PASRR Evaluation: This document is required for individuals who meet certain criteria during the Level I screening. It provides a more in-depth assessment of mental health and intellectual disabilities.
  • Physician's Certification for Terminal Illness: This certification is necessary when a patient is deemed to have a life expectancy of less than six months. It supports eligibility for specific Medicaid services.
  • Discharge Summary: A summary from a hospital or facility that outlines the patient’s medical history, treatment received, and recommendations for follow-up care. It is essential for continuity of care.
  • Consent for Release of Information: This form allows healthcare providers to share a patient’s medical information with relevant parties. It is crucial for coordinating care and ensuring compliance with privacy laws.
  • Behavioral Health Assessment: This document evaluates the mental health status of the individual. It provides insights into their needs and informs treatment planning.
  • Care Plan: A care plan outlines the goals, interventions, and services required for the individual’s health and well-being. It is developed collaboratively by healthcare providers and the patient.
  • Bill of Sale Form: This is a crucial document used to transfer ownership of personal property. It serves as a receipt for the transaction and can include details such as the item's description, sale price, date of sale, and ensures clarity in the agreement between parties. For more information, you can visit All Florida Forms.
  • Financial Eligibility Verification: This form verifies the financial status of the applicant to determine their eligibility for Medicaid. It includes income, asset details, and household composition.

These documents work together to create a comprehensive view of the individual’s needs and eligibility for services. Proper completion and submission of each form are vital for ensuring that individuals receive the necessary support and care.

File Specs

Fact Name Details
Form Title Nevada Medicaid and Nevada Check Up Programs First Health Services Corporation LEVEL I IDENTIFICATION SCREENING (for PASRR)
Confidentiality The form is marked as "CONFIDENTIAL" to protect patient information.
Governing Law This form is governed by Nevada Medicaid regulations and federal PASRR requirements.
Submission Date Sections for "INITIAL" and "UPDATE" submissions are included for tracking purposes.
Patient Information Required details include patient name, SSN, home address, and Medicaid billing number.
Screening Sections The form includes sections for Mental Illness, Mental Retardation, and Dementia screenings.
Intervention Options Options for intervention to prevent hospitalization are detailed, including supportive living.
Exempted Hospital Discharge Criteria for Exempted Hospital Discharge (EHD) is specified, allowing certain individuals to bypass PASRR Level II.
Review Process The form includes sections for FHSC use only, indicating internal review and decision-making processes.