(S-3152-2026

1. Click ‘Get Form’ to open the (S-3152 in the editor.
2. Begin with Part I, where you will enter the institutionalized person's identification details. Fill in their last name, first name, middle name, Medicaid Card ID Number, Social Security Number, date of birth, and telephone number. Ensure that the address is complete for accurate processing.
3. Proceed to Part II, which contains the statement of the attending physician. Here, indicate whether it is reasonable to expect that the person will be discharged from long-term care by selecting 'Yes' or 'No'. If 'Yes', provide an estimated period of care.
4. In this section, detail the medical reasons supporting your expectation regarding discharge. This information is crucial for proper assessment.
5. Finally, as the attending physician, certify your statements by signing and printing your name. Include your address and contact information before submitting the form.

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