Pa 1768 form 2006-2025

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The document is a form for Home and Community Based Services (HCBS) that outlines eligibility, ineligibility, and changes in status for applicants or recipients. It includes sections for demographic information, assessment details, agency information, and instructions for completing the form. The form is used to verify whether an individual meets the level of care required for HCBS and to document any changes such as transfers, terminations, or financial status updates.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (98 Votes)
2019	4.3 Satisfied (36 Votes)
2019	4.8 Satisfied (69 Votes)
2017	4.8 Satisfied (108 Votes)
2016	4.8 Satisfied (238 Votes)
2016	4.8 Satisfied (145 Votes)
2016	4.8 Satisfied (114 Votes)
2016	4.3 Satisfied (176 Votes)
2016	4.5 Satisfied (53 Votes)
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2014	4.8 Satisfied (178 Votes)
2011	4.2 Satisfied (51 Votes)
2011	4.8 Satisfied (61 Votes)
2011	4.8 Satisfied (86 Votes)
2010	4.9 Satisfied (481 Votes)

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What is the PA 1917 form?

In order to determine if a non-citizen is eligible to receive EMA, a licensed physician, physician assistant, or certified registered nurse practitioner must complete a PA 1917 Form, which describes the emergency medical condition and the emergency medical treatment needed, including any hospitalization dates for

What is the PA 1768 form?

This form will be used by all HCBS agencies statewide to inform County Assistance Office (CAO) staff about applicants and recipients eligibility, or ineligibility for an HCBS Program including the Long-Term Care Capitated Assistance Program (LTCCAP). CAOs will begin receiving the PA 1768 on January 3, 2006.

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