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This version of the form is not currently in use and is provided for reference only. Download this version of
Form SFN61362
for the current year.
Form SFN61362 Initial Application for the Optional Alzheimer's, Dementia, Special Memory Care, or Traumatic Brain Injury Services in a Basic Care Facility - North Dakota
What Is Form SFN61362?
This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form SFN61362?A: Form SFN61362 is the Initial Application for the Optional Alzheimer's, Dementia, Special Memory Care, or Traumatic Brain Injury Services in a Basic Care Facility in North Dakota.
Q: Who is eligible to apply for these services?A: Individuals with Alzheimer's, dementia, special memory care needs, or traumatic brain injury who are seeking services in a basic care facility in North Dakota are eligible to apply.
Q: What is the purpose of this form?A: The purpose of this form is to apply for the optional services provided to individuals with Alzheimer's, dementia, special memory care needs, or traumatic brain injury in a basic care facility in North Dakota.
Q: Are there any fees associated with this application?A: There may be fees associated with this application. Please refer to the instructions provided with the form or contact the relevant North Dakota government agency for more information.
Q: What supporting documents do I need to include with the application?A: You may need to include supporting documents such as medical records, diagnosis reports, and other relevant documentation with the application. Please refer to the instructions provided with the form for a complete list of required documents.
Q: How long does it take to process the application?A: The processing time for the application may vary. Please contact the relevant North Dakota government agency for an estimate of the processing time.
Q: Can I apply for these services on behalf of someone else?A: Yes, you can apply for these services on behalf of someone else. Please indicate your relationship to the applicant and provide any necessary documentation or authorization.
Q: What happens after the application is submitted?A: After the application is submitted, it will be reviewed by the appropriate North Dakota government agency. You will be notified of the decision regarding the application.
Form Details:
- Released on December 1, 2017;
- The latest edition provided by the North Dakota Department of Health and Human Services;
- 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 fillable version of Form SFN61362 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
Download Form SFN61362 Initial Application for the Optional Alzheimer's, Dementia, Special Memory Care, or Traumatic Brain Injury Services in a Basic Care Facility - North Dakota
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