Pae certification form 2026

1. Click ‘Get Form’ to open the PAE Certification Form in the editor.
2. Begin by entering the applicant’s name and Social Security Number (SSN) in the designated fields at the top of the form.
3. Attach a recent History and Physical or other medical records that support the applicant's needs. Ensure these documents are included when submitting your form.
4. In the Physician Certification section, have a qualified physician complete and sign this part, certifying that nursing facility services are necessary for the applicant.
5. Fill in any relevant diagnoses related to the applicant’s functional or skilled nursing needs in the provided space.
6. If recertification is needed, complete that section only if applicable, ensuring it is also signed by a qualified medical professional.

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