Pa 1572 resource assessment-2025

See details

4.8 out of 5

61 votes

The document provides instructions for completing the Resource Assessment Form (PA 1572) for couples where one spouse is in a nursing facility or receiving Home and Community Based Services (HCBS). It outlines the importance of protecting a portion of the couple's resources under Medical Assistance rules, specifically addressing spousal impoverishment provisions. The form is used to determine how much of the couple's total resources can be protected for the community spouse and what must be spent before eligibility for Medical Assistance. It includes detailed verification requirements for various types of resources and emphasizes the need for accurate documentation.

Here's how it works

01. Edit your pa1572 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send pa 1572 form via email, link, or fax. You can also download it, export it or print it out.

How to modify Pa 1572 resource assessment online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork requires only some simple clicks. Make these fast steps to modify the PDF Pa 1572 resource assessment online free of charge:

Sign up and log in to your account. Sign in to the editor using your credentials or click Create free account to evaluate the tool’s features.
Add the Pa 1572 resource assessment for editing. Click on the New Document option above, then drag and drop the sample to the upload area, import it from the cloud, or via a link.
Adjust your file. Make any adjustments needed: add text and images to your Pa 1572 resource assessment, highlight important details, erase parts of content and substitute them with new ones, and add icons, checkmarks, and fields for filling out.
Complete redacting the template. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is super easy to use and efficient. Try it now!

See more pa 1572 resource assessment versions

We've got more versions of the pa 1572 resource assessment form. Select the right pa 1572 resource assessment version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (98 Votes)
2019	4.3 Satisfied (36 Votes)
2019	4.8 Satisfied (69 Votes)
2017	4.8 Satisfied (108 Votes)
2016	4.8 Satisfied (238 Votes)
2016	4.8 Satisfied (145 Votes)
2016	4.8 Satisfied (114 Votes)
2016	4.3 Satisfied (176 Votes)
2016	4.5 Satisfied (53 Votes)
2016	4.1 Satisfied (20 Votes)
2014	4.8 Satisfied (178 Votes)
2011	4.2 Satisfied (51 Votes)
2011	4.8 Satisfied (61 Votes)
2011	4.8 Satisfied (86 Votes)
2010	4.9 Satisfied (481 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What is the PA 635 form?

A Pennsylvania Medicaid prior authorization form is a document used to obtain Medicaid coverage for non-preferred drugs in the state of Pennsylvania. A physician must submit this form when they wish to treat a Medicaid patient with a medication that is not on the states preferred drug list.

What is the purpose of the 1572 form?

A form that must be filed by an investigator running a clinical trial to study a new drug or agent. The investigator agrees to follow the U.S. Food and Drug Administration (FDA) Code of Federal Regulations for the clinical trial.

What is a PA 1572 form?

The purpose of this Resource Assessment Form is to determine how much of a married couples total resources may be protected or set aside for the community spouse, and how much, if any, must be spent before the individual in the nursing facility or assessed eligible for HCBS may be eligible for Medical Assistance

What is the MA 51 form in Pennsylvania?

This Medical Assessment Form (PA 635) is needed to determine whether an individual is able to participate in employment and training activities, what treatment plan(s) could help the individual move towards employment, or determine if the individual is a good candidate for disability benefits or is pregnant.

What is a PA-4 form for Medicaid?

The PA-4 form will be used to assist the assessor in determining whether home and community based long-term care services can best meet the needs of the individual. Complete the top portion of the PA-4 with the individuals name, address, phone number, date of birth, veteran status, Social Security and Medicaid number.

pa 1572

Pa 1572 resource assessment pdf PA 1572 form PDF PA-4 form PA 1768 form

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What is the abortion form for PA Medicaid?

A physician must certify an abortion is necessary due to a life threatening condition on the DHS Physician Certification for an Abortion (MA-3) form. You may access the MA-3 form at webcontent/documents/form/s002553.

Pa 1572 resource assessment-2025

Here's how it works

How to modify Pa 1572 resource assessment online

See more pa 1572 resource assessment versions

Complete this form in 5 minutes or less

Got questions?

What is the PA 635 form?

What is the purpose of the 1572 form?

What is a PA 1572 form?

What is the MA 51 form in Pennsylvania?

What is a PA-4 form for Medicaid?

Complete this form in 5 minutes or less

People also ask

What is the abortion form for PA Medicaid?

resource assessment form pa 1572

Try more PDF tools