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Click ‘Get Form’ to open the DHS-3244P-ENG form in the editor.
Begin by entering the 'Date of Referral' in mm/dd/yy format. Indicate whether this is for an 'Initial Assessment' or 'Reassessment' by checking the appropriate box.
Fill out the recipient information section completely, including name, address, phone number, and date of birth. Ensure all fields are legible to avoid delays.
Verify eligibility through EVS by entering the verification date and selecting the major program applicable to the recipient.
Complete the physician information section with details about the recipient's physician and clinic, ensuring accuracy for effective communication.
In the PCA provider(s) information section, provide details about your agency and include NPI/UMPI codes as required.
Address language needs by indicating if an interpreter is necessary and specify any additional comments regarding living arrangements or diagnosis.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (135 Votes)
2011	4.3 Satisfied (131 Votes)
2008	4 Satisfied (35 Votes)

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