Disclosure of charges 2026

1. Click ‘Get Form’ to open the Adult Family Home Disclosure of Charges in the editor.
2. Begin by entering the home/provider’s name, date, and license number at the top of the form. This information is essential for identifying the specific adult family home.
3. Review the Medicaid Information section carefully. Ensure you understand how Medicaid payments are accepted and any conditions that apply.
4. Fill out the Admission Fees section if applicable. Clearly state any admission fees required by the home, including additional comments if necessary.
5. Proceed to Deposits and Prepaid Charges sections. Specify amounts and purposes for each deposit or prepaid charge, ensuring full disclosure as required.
6. Complete Other Fees/Charges by detailing any additional costs associated with services provided, such as transportation or personal care assistance.
7. Finally, review all sections for accuracy before saving your completed form. Utilize our platform's features to easily share or print your document.

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