Maine DHHS - Questionnaire - RDS

Instructions: RDS is required to be completed only for Section 17 CI, ACT, CRS and Section 92 Adult BHH services. DO NOT ENTER AN UNMET NEED if the member has the service or will have it within 30 days.

Status: Incomplete
   


1. What is the ISP Status?

(Please select one.)


2. Date current ISP was completed:

Date:



3. Are there unmet needs?

(Please select one.)



Disclaimers (please check to confirm acceptance):