Nursing ah application form 2026

1. Click ‘Get Form’ to open the Nursing Facility/Acute Hospital Waiver Application in the editor.
2. Begin by entering the applicant’s name and contact information in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the applicant's date of birth, age, gender, and marital status. This demographic information helps in assessing eligibility.
4. Indicate the county of residence and current living situation (home, hospital, etc.). This section is vital for determining local resources available to the applicant.
5. Provide details about health care insurance coverage. If applicable, include Medi-Cal and Medicare numbers as these are essential for financial assessments.
6. List current medical diagnoses and check any relevant medical needs from the provided options. Use additional space for any specific requirements not listed.
7. Complete sections regarding legal authority for health care decisions and current service providers. This ensures that all necessary support systems are identified.
8. Review all entries for accuracy before submitting. Once completed, return the form to the specified address on the first page.

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