Msa 0737-2026

1. Click ‘Get Form’ to open the msa 0737 in the editor.
2. Begin with Section 1, entering the Client Information. Fill in the Client's name, CSHCS or Medicaid ID, date of birth, and home address clearly. Ensure all fields are completed accurately.
3. Proceed to Section 2 for Responsible Relative/Court-Appointed Guardian Information. Provide names and contact details for guardians, ensuring that at least one is a U.S. citizen.
4. In Section 3, detail any health coverage and insurance information. Check applicable programs and list any other insurance policies covering the client.
5. Complete Section 4 by providing health care information including primary care doctor details and any specialty doctors treating the client.
6. Fill out Section 5 regarding involvement of others in the household who have CSHCS.
7. Finally, review Section 6 for Agreement, Certification, and Signatures. Ensure all required signatures are obtained before submission.

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