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The MnCHOICES Assessment Referral Form is a document used to collect essential information for individuals seeking long-term services and supports. It includes sections for client details, legal authority, insurance status, providers, diagnosis, assistance needs, and referral reasons. The form must be completed and submitted via email or fax to the appropriate intake department.

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Versions	Form popularity	Fillable & printable
2023	4.1 Satisfied (45 Votes)
2020	4.9 Satisfied (52 Votes)

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What is the alternative care program in Anoka County?

The Alternative Care (AC) Program is for individuals, over the age of 65, with low income and assets who do not qualify for Medical Assistance. This program provides financial assistance for seniors, who meet nursing facility level of care, to allow access to home care services and supports.

What is the phone number for the Minnesota Choice Assessment?

Request a MnCHOICES intake assessment by filling out the online MnCHOICES Referral Form or by calling 651-266-3613.

How do I schedule a MN Choice assessment?

To schedule a MnCHOICES assessment, call the county or tribal nation where you live. Use the Minnesota tribal and county directory to find contact information for the county health care office.

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