470 3372-2026

1. Click ‘Get Form’ to open the 470 3372 in the editor.
2. Begin by entering the 'Name of Member' and 'Name of CDAC Provider' at the top of the form. Ensure that all names are spelled correctly for accurate processing.
3. In the 'Agreement' section, both the member and CDAC provider must review and confirm their understanding of responsibilities. This includes detailing emergency plans and evaluating the provider's qualifications.
4. Fill out the 'Standards for the CDAC provider' section, ensuring to check off necessary skills and provide documentation evidence as required.
5. Complete the service activities provided by entering time requirements for each activity listed under non-skilled and skilled service components.
6. Finally, ensure all signatures are obtained from the member, CDAC provider, and case manager before submitting. Save your completed form securely within our platform for future reference.

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