LTC/County Communication Form
The Physician Certification Form (DHS-1503) provides you with very specific information. Sometimes you will need additional information from the LTCF that is not provided on that form. Or you may need to provide information to the LTCF.
The DHS-3050 (PDF), LTC/County Communication Form, has been created to help you communicate with the LTCF.
To Do: Take out your copy of the DHS-3050.
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Level of Care Requirement - LTC Screenings - LTCF