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General Forms | LTC and Community Service | Chronic & Specialty Care | Acute Care

Document/Directory Last Updated

General Forms   Hospital Contact Form 9/4/2007 Facility Contact Form 9/4/2007 Pre-admission Certification 1/5/2007 257 1/5/2007 iEXCHANGE manual for Acute Care 1/17/2007 iExchange Hints & Tips 1/17/2007 iEXCHANGE for 3871b 1/17/2007 Provider Login Step by Step 1/17/2007 iEXCHANGE Administration Training 1/30/2007   Long Term Care and Community Services    DHMH 259 - Medical Care Transaction Form 1/5/2007 DHMH 3871 - Medical Eligibility Review Form 1/5/2007 DHMH 3871B - Medical Eligibility Review Form 1/5/2007 DHMH 3871B - Additional Information Form 1/30/2007 DHMH2129 - Report of Administrative Days in LTC 1/5/2007 DHMH 4345 - Mental Illness and Mental Retardation or Related Conditions 1/30/2007 Ventilator Questions 1/30/2007 Vent Comorbidity Rating Scale 1/30/2007 Leave of Absence 1/30/2007 AERS Continued Stay Dates Form 2/6/2006   Chronic and Specialty Hospitals    DHMH 3871 - Medical Eligibility Review Form 1/5/2007 DHMH 3871B - Medical Eligibility Review Form 1/5/2007 DHMH 3871B - Additional Information Form 1/30/2007 Vent Comorbidity Rating Scale 1/30/2007 Ventilator Questions 1/30/2007 Rehab Specialty Certification Form 1/30/2007 3808 Corrections Cover Sheet 3/2/2007   Acute Care Forms   Instructions for Completion of HS Fax Form 1/25/2007 DHMH 1288 - Administrative Days 1/25/2007 DHMH 3808 - Admission and LOS Certification 1/25/2007 DHMH 3871b - Medical Eligibility Review 1/30/2007 DHMH 3871b - Medical Eligibility Review Form 1/25/2007 DHMH 3871B - Additional Information Form 1/30/2007 Hospital Services Authorization Fax Form 1/25/2007 Hospital Services Authorization Request Fax -Editable 1/25/2007 DHMH 4345 - Mental Illness and Mental Retardation or Related Conditions 1/30/2007 Facility Identified Non-Acute Days 1/30/2007 Vent Comorbidity Rating Scale 1/30/2007 Ventilator Questions 1/30/2007 3808 Important Billing Information 2/12/2007 3808 Hospital Memo 2/12/2007