Maine DHHS - Questionnaire - Rehabilitative and Community Support (RCS)


Status: Incomplete
   

Rehabilitative and Community Support (RCS)


1. Functional Assessment Scores within the past two years:



2. Date of Functional Assessment:

Date:



3. Name and credentials of who completed the assessment:


Instructions: A Physician letter does not need to be uploaded at each request.

4. Has a Physician Letter for members under six years of age been uploaded?

(Please select one.)


5. Has this member received all authorized units of service during the last review period?

(Please select one.)



Disclaimers (please check to confirm acceptance):