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Facesheet: 1 Request Information (1 of 2)

Facesheet: 1 Request Information (1 of 2) 2025

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The document outlines the Montana Medicaid agency's request for a 1915(b) waiver amendment, specifically for the Passport to Health program, which is a Primary Care Case Management (PCCM) initiative. The amendment seeks to modify existing provisions and extend the waiver for an additional two years, starting from July 1, 2018. It details the types of programs authorized under the waiver, including Team Care and Nurse First programs, and describes the state's efforts in tribal consultation and program history. The document also includes information on service delivery systems, populations served, monitoring activities, quality assurance measures, and cost-effectiveness analysis related to the waiver. Overall, it emphasizes maintaining access to quality healthcare services while ensuring compliance with federal regulations.

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Click 'Get Form' to open the Facesheet: 1 Request Information (1 of 2) in our platform's editor.
Begin by filling out Section A, where you will provide details about the waiver request. Include the name of the waiver program and its short and long titles.
In Section B, specify the type of request. Check the box for 'Amendment request for an existing waiver' and indicate which sections are being modified.
For Section C, select the requested approval period from one to five years based on your needs.
Complete Section D by entering effective dates for both the base waiver and proposed amendment. Ensure all dates are formatted correctly.
Review all entered information for accuracy before saving or exporting your completed form.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What information can you find in a clients face sheet?

Patient Info Name (including the patients Preferred Name, if available) Medical Record Number (MRN/unique patient ID). Sex (Male, Female, or unknown) Date of Birth (DOB) Preferred Language. Contact Information. SMS Consent.

What information is on a face sheet?

The Face Sheet provides an easily accessible summary list of problems/diagnosis, medications, allergies, miscellaneous notes, patient history notes, surgical history notes, patient annotations, recalls, as well as any test, lab, and image procedures orders for the patient.

What is a face sheet in medical billing?

0:02 0:59 The part of my event that theyre going to be talking at or used for. And then I also will includeMoreThe part of my event that theyre going to be talking at or used for. And then I also will include pronunciation. So if they have a a name that is tough to pronounce.

What is included on a face sheet?

What is a Facesheet? Facesheet is a complete and comprehensive list of the patients medical history, including allergies, problem lists, chief complaints, social history, smoking history, vital signs, etc. Data gets added to the facesheets respective headers when a patient chart is saved.

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