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Iowa Admin. Code r. 441-177.4 - Eligibility and application | State
Application for in-home health-related care shall be made on Form 470-5170 or 470-5170(S) and submitted to the department. An eligibility determination
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18-C(6), In-Home Health-Related Care Services
Feb 17, 2023 Give a copy of signed form 470-3951 or 470-3951(S),. Authorization to Obtain or Release Health Care Information, to the provider along with form
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470-4389 Consumer-Directed Attendant Care (CDAC)
This form is to record the services you provide. It is required that you fill out one of these forms every day that you provide services. Your billings may.
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