How to Send the Form
Due to the sensitivity of the information (private data) that is being shared on this form it can only be sent via inter-office mail, fax or through the U.S. Postal Service. At this time, due to encryption issues, the DHS-5181 should not be sent via email unless it does not leave a county email server.
A list of health plan and county contacts is available to your county to make communication easier. Check with your lead worker or your supervisor for contact list information.
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Level of Care Requirement - LTC Screenings - Waivers