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How to use or fill out disclosure charges with our platform
- Click ‘Get Form’ to open the Adult Family Home Disclosure of Charges in the editor.
- Begin by entering the home/provider’s name and license number at the top of the form. This information is crucial for identification.
- Fill in the date to ensure that your document is current. This helps maintain clarity regarding when the charges were disclosed.
- Proceed to each section, starting with Medicaid Information. Clearly indicate whether the home accepts Medicaid payments and provide any additional comments as necessary.
- For Admission Fees, Deposits, and Prepaid Charges, specify amounts and purposes. Ensure you provide full disclosure as required by regulations.
- Continue through sections detailing Daily/Monthly Rates, Personal Care, Medication Services, Other Services, Items, Activities, and Other Charges. Fill in all applicable fields accurately.
- Finally, ensure that both resident and provider sign and date the Resident Acknowledgement of Receipt section to confirm understanding of charges.
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