Dhs 1147 instructions-2025

1. Click ‘Get Form’ to open the DHS Form 1147 in the editor.
2. Begin by checking the appropriate box for the evaluation type: initial, annual, reconsideration, or other review.
3. Enter the patient's name and birthdate in the designated fields. Ensure accuracy as this information is crucial.
4. Indicate the patient's gender by selecting 'M' for male or 'F' for female.
5. For Medicare eligibility, check the relevant boxes and input the Medicare I.D. number if applicable.
6. Specify Medicaid eligibility by selecting 'Yes' or 'No', and provide the Medicaid I.D. number if available.
7. Fill in the present address of the patient, choosing from options like Home, Hospital, Nursing Facility, etc.
8. Complete sections regarding attending physician details and return form contact information accurately.
9. For referral information, complete all sections if it’s an initial request; skip if it’s an annual review.
10. Finally, ensure all assessment information is filled out correctly before submitting your form electronically through our platform.

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