Form OHIP-0103 Attestation of Immediate Need for Personal Care Services / Consumer Directed Personal Assistance Services - New York

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Form OHIP-0103 Attestation of Immediate Need for Personal Care Services / Consumer Directed Personal Assistance Services - New York

What Is Form OHIP-0103?

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form OHIP-0103?
A: Form OHIP-0103 is the Attestation of Immediate Need for Personal Care Services/Consumer Directed Personal Assistance Services in New York.

Q: What is the purpose of Form OHIP-0103?
A: The purpose of Form OHIP-0103 is to attest to the immediate need for personal care services or consumer-directed personal assistance services.

Q: Who needs to fill out Form OHIP-0103?
A: Individuals in New York who need personal care services or consumer-directed personal assistance services need to fill out Form OHIP-0103.

Q: What information is required on Form OHIP-0103?
A: Form OHIP-0103 requires information such as the individual's name, contact information, Medicaid ID, and a description of their immediate need for services.

Q: Is there a deadline for submitting Form OHIP-0103?
A: There isn't a specific deadline mentioned for submitting Form OHIP-0103. It should be filled out as soon as there is an immediate need for personal care services or consumer-directed personal assistance services.

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Form Details:

  • The latest edition provided by the New York State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form OHIP-0103 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.

Download Form OHIP-0103 Attestation of Immediate Need for Personal Care Services / Consumer Directed Personal Assistance Services - New York

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