Kentucky map 24 form 2026

1. Click ‘Get Form’ to open the Kentucky Map 24 form in the editor.
2. Begin by entering the recipient's name and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the previous address, including city, state, and ZIP code. This helps maintain a clear record of the recipient's history.
4. Indicate the admission date to the nursing facility or waiver agency. Select the appropriate placement status from options like Nursing Facility Bed or ICF/DD Bed.
5. If applicable, provide details about discharge or expiration dates, along with the name and address of any new facility if transferred.
6. Complete any additional sections related to Home and Community Based Waiver Services, ensuring all relevant dates are filled out accurately.
7. Finally, sign the document electronically using our platform’s signature feature before submitting it for processing.

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