3871 form-2025

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The document is a Maryland Medical Assistance Program Medical Eligibility Review Form, used to assess and document the medical and financial eligibility of patients for various levels of care, including nursing facilities, rehabilitation hospitals, and medical day care. It includes sections for patient demographics, physician's plan of care, functional status assessments, cognitive/behavioral evaluations, and physician certification for level of care.

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Versions	Form popularity	Fillable & printable
1995	4.8 Satisfied (238 Votes)

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