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Nursing Home Application Form

Nursing Home Application Form

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_________________________________________ Telephone No. ________________ Street ________________________________________________________________________ City State County Zip Code Birth Date______________________ Age_________ Sex _______ Citizenship __________________ Marital Status:  Single Married Widowed Separated Divorced Name of Spouse _________________________________ Spouse SS #_________________________ Present Location of Applicant (if other than home address)...
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Instructions and help about nursing home application for medicaid

Hello my name is Aaron and my name is Russell today we've made this video to help nursing facilities understand the can care application for the elderly and people with disabilities we know that nursing facility staff are often the ones helping individuals and families fill out the Medicaid application throughout this presentation we will provide information about the KC 1500 application for medical assistance for the elderly and persons with disabilities not to be confused with the KC 1100 which is the application for families with children make sure the consumer is filling out the KC 1500 our learning objectives for today are to summarize the important sections of the application what to document who to document information for and what kind of information is needed to recognize the importance of completing the application in its entirety and to demonstrate the ability to complete the application for medical assistance for the elderly and persons with disabilities the application num

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