DHS-3050 – Requesting Information
The DHS-3050 can be used to request the following:
- Completion of the DHS-1503.
- Admission or discharge date.
- Cost of care amounts.
- Third party payment information, including Medicare.
- Asset information in the form of a resident fund.
- Other information as needed.
To Do: Look at a completed DHS-3050 (PDF) to see an example of how the form may be used.
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Level of Care Requirement - LTC Screenings - LTCF