Ultc 100 2 2025

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4 out of 5

36 votes

The document is a comprehensive assessment form used for initial screening and intake of individuals seeking long-term care services. It includes sections on the applicant's living situation, personal information, presenting problems, areas of concern regarding daily activities, potential community-based programs, financial information, medical assessments, and eligibility criteria for Medicaid long-term care services. The form aims to evaluate the individual's needs in various activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as well as their mental health status and support systems.

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Click ‘Get Form’ to open the ultc 100 2 in the editor.
Begin by filling in the 'Agency' and 'Date Referral Completed' fields at the top of the form. Ensure accuracy as this information is crucial for processing.
In the 'Applicant Information' section, enter details such as State ID, Last Name, First Name, DOB, and SSN. This data is essential for identification purposes.
Proceed to the 'Current Living Situation' section. Select one of the options that best describes the applicant's living arrangement by clicking on the appropriate checkbox.
In 'Presenting Problems and Diagnoses', provide any relevant comments regarding health issues or concerns that may affect care needs.
Complete sections on financial information and insurance details accurately to ensure eligibility for services.
Review all entered information for completeness and accuracy before submitting your form through our platform.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (147 Votes)
2003	4 Satisfied (36 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long does it take to get approved for long-term care?

Health Screening and Underwriting Depending on your age and health issues, a face-to-face assessment in your home may be required too. The underwriting process typically takes from 4 6 weeks depending on how quickly your medical records are received and reviewed.

What is the 5 year rule for Medicaid in Colorado?

Colorado Medicaids look-back rule This is the 5-year period that immediately precedes ones date of application. During the look-back, Medicaid checks all asset transfers to ensure none were sold or gifted under fair market value. This includes asset transfers made by ones spouse.

How long does it take to be approved for Colorado Medicaid?

It may take up to 45 days or up to 90 days if the application requires a disability determination from the date your application was received for a case number to be assigned to you. Once you are assigned a case number, you can check your status and benefits online through Colorado PEAK.

What is the value of p 100 2?

The value of 100P2 is 9900. Step-by-step explanation: 100P2 stands for the number of permutation of 100 different things taken 2 at a time.

What is the income limit for Colorado Medicaid?

Approximate Monthly Income To Qualify for Health First Colorado Family SizeAdults 19-65Children 0-18 Family of 1 up to $1,670 up to $1,783 Family of 2 up to $2,266 up to $2,419 Family of 3 up to $2,862 up to $3,056 Family of 4 up to $3,458 up to $3,6921 more row

long term care professional medical information form

100.2 assessment PMIP form PMIP form pdf Long term care Professional Medical Information form Request for Long-Term Care Medical Services How to get long-term care Medicaid DHS long-term care Long-term care insurance Colorado

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How do I apply for long term Medicaid in Colorado?

Apply For Health First Colorado Apply by phone: Call 1-800-221-3943 / State Relay: 711. Phone applications are available Monday through Friday from 8 a.m. to 4 p.m. Apply by mail: Download and print a paper application. Explore options: If you applied and didnt qualify, you can learn more about your options.