Abcdm 83 2025

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The document is a notification form used by the Oklahoma Department of Human Services (OKDHS) to inform about the admission or discharge of patients in nursing facilities, intermediate care facilities for the mentally retarded, or hospices. It includes sections for patient information, admission details, and discharge notifications, as well as instructions for completing and submitting the form to ensure accurate processing of claims and assistance for patients.

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Click ‘Get Form’ to open the abcdm 83 in the editor.
In the 'To' section, enter the address of the local OKDHS office where the form will be submitted.
In the 'From' section, provide your facility's name, address, and provider number.
Under 'Re:', fill in the patient's name, former address, client ID number, SoonerCare case number (if applicable), Social Security or health insurance benefit number, date of birth, sex, and race. Indicate if the patient is in a Title XVIII certified skilled bed and whether they will remain after skilled care days end.
For Section I (Admission), enter the admission date and previous location. Check if SoonerCare financial and medical eligibility is approved. Specify if it's a new patient or returning from a hospital.
Complete Section II (Discharge) by entering the discharge date and indicating where the patient was discharged to or if they entered a hospital.
Finally, ensure that an operator or representative signs and dates the form before submission.

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