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Elderchoices pers provider application form 2026

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The document outlines the Personal Emergency Response System (PERS) application and certification process for providers serving elderly individuals. It defines PERS as a 24/7 in-home electronic support system that enables immediate communication with an emergency control center. The document details procedural requirements, equipment specifications, emergency procedures, staffing responsibilities, documentation standards, confidentiality protocols, and provider assurances necessary for compliance with the Arkansas Department of Human Services' ElderChoices Program.

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Click ‘Get Form’ to open the elderchoices pers provider application form in the editor.
Begin with Section One, where you will enter your Provider Information. Fill in the Name of Provider Agency, EIN Number, and address details accurately.
Proceed to Section Two, which contains specific questions about your PERS services. Answer each question thoroughly, ensuring clarity and completeness.
In Section Three, attach all required documentation as specified. This includes compliance certificates and staff training records.
Complete Section Four by certifying the information provided is true. Ensure that the Principal Official signs and dates this section.
Review all sections for accuracy before submitting. Utilize our platform’s editing tools to make any necessary adjustments easily.

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