Dss 3139-2026

1. Click ‘Get Form’ to open the dss 3139 in the editor.
2. Begin by filling out the 'Reason for Preparation' section, selecting from options like 'Admission to LTHHCP' or 'Initial Evaluation for Home Health Aide'.
3. In the 'Patient Name' and 'Resident Address' fields, enter the patient's full name and current address, ensuring accuracy for effective communication.
4. Complete the 'Next of Kin/Guardian' section with relevant contact information, including their relationship to the patient.
5. Fill in patient details such as date of birth, sex, marital status, and insurance numbers in the designated fields.
6. For sections requiring input from a Social Service Worker (SSW), ensure that all relevant care providers and community support services are documented accurately.
7. Review all entries for completeness before saving or sharing your filled form directly through our platform.

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