DHS Search Results
-
Prenatal Care Coordination Care Coordinator Visit Checklist
… Discuss maternal seatbelt use and infant car safety Referrals for Resources Basic Needs (Food, Clothing, Housing) Make sure member has access to appropriate food, clothing, and housing, and provide referrals if necessary Transportation Assistance Make sure … seatbelt use and infant car safety 1: Off Make sure member has access to appropriate food, clothing, and housing, and provide referrals if necessary 2: Off Make sure member has access to … -
Divestment Penalty and Undue Hardship Notice Plus Waiver Request
… not be able to pay for: • Medical care, which would put your health or life at risk • Food • Clothing • Shelter • Other necessities of life How to Request an Undue Hardship Waiver To request … for one of the following: • Medical care, which would put your health or life at risk • Food • Clothing • Shelter • Other necessities of life b. If you applied for any of these programs: Home … meet your medical and remedial needs. • An estimate of your monthly costs for food, shelter, clothing, and other necessities of life. UH F-10193 Page 4 of 5 SECTION 2: DESCRIPTION (REQUIRED) … -
Instructions: Personal Care Screening Tool (PCST)
… means cleansing all surfaces of the body and bathing includes assistance with changing clothing, getting in and out of the tub or shower; wetting, soaping, and rinsing skin; shampooing … related to garment closures (e.g., zippers, buttons) at the back of the garment. Typical clothing changes are from sleepwear to daywear and from daywear to sleepwear. Do not include … Body A. Member is able to dress upper body without assistance or is able to dress self if clothing is laid out or handed to the person: • Member is independent in dressing upper body and … -
General Pediatric Clinic - 24 Month Visit
… — Provider Date Signed Puts a toy on the floor Gives the toy to the mother Puts on some clothing alone Return to clinic in _____ months. Uses spoons well, spilling very little Washes … toy to the mother: Gives the toy to the mother: OGives the toy to the mother: OPuts on some clothing alone: NOPuts on some clothing alone: Puts on some clothing alone: RPuts on some clothing alone: RUses spoons well, … -
Sample Undue Hardship Letter
… not be able to pay for: ∙ Medical care, which would put your health or life at risk ∙ Food ∙ Clothing ∙ Shelter ∙ Other necessities of life How to Request an Undue Hardship Waiver To request … one of the following: ∙ Medical care, which would put your health or life at risk; ∙ Food; ∙ Clothing; ∙ Shelter; or ∙ Other necessities of life. b. If you applied for any of these programs: … your medical and remedial needs and o An estimate of your monthly costs for food, shelter, clothing, and other necessities of life. EX AM PL E PIN: 9876543210 Date: MM/DD/CCYY Page 4 of 5 … -
Personal Care Screening Tool (PCST)
… “Bathing” means cleansing all surfaces of the body and includes assistance with changing clothing, getting in and out of the tub or shower, wetting, soaping, and rinsing skin, shampooing … activities with garment closures (e.g., zippers, buttons) at the back of the garment. Typical clothing changes are from sleepwear to daywear and from daywear to sleepwear. Upper Body Upper … is able to dress the upper body without assistance or is able to dress him- or herself if clothing is laid out or handed to him or her. |_| B. Member is able to dress the upper body by … -
General Pediatric Clinic - 15 Month Visit
… appropriate 2 + other single words Points to a named part of the body P.S. Removes a piece of clothing SIGNATURE — Provider Date Signed Drinks from a cup alone Uses spoon with spilling … NOPoints to a named part of the body: Points to a named part of the body: RRemoves a piece of clothing: ORemoves a piece of clothing: Genitalia - 1: NORemoves a piece of clothing: RDrinks from a cup alone: NODrinks from a … -
General Pediatric Clinic - 18 Month Visit
… Puts a toy under the table Puts a toy on the floor Gives a toy to the mother P.S. Removes own clothing SIGNATURE — Provider Date Signed Imitates simple housework Uses spoon with spilling … a toy to the mother: NOGives a toy to the mother: Gives a toy to the mother: RRemoves own clothing: ORemoves own clothing: NORemoves own clothing: OImitates simple housework: NOImitates simple housework: … -
General Pediatric Clinic - 3 to 4 Week Visit
… P.S. Seeks Eye Contact Smiles Responsively Smiles Spontaneously Anticipatory Guidance: Clothing, breathing, crying, outings, look for response to noise. Holding baby: Mom knows or … will adjust after a few days and the baby will be back on schedule. Anticipatory Guidance Clothing — Basic cotton shirt and diaper, add as necessary. Most babies don’t need more clothes … than average adult. Find out by feeling baby’s body, it should be warm but not hot. No tight clothing with long strings, cover hands and feet, especially if the baby scratches. Allow room to … -
Personal Care Screening Tool (PCST)
… “Bathing” means cleansing all surfaces of the body and includes assistance with changing clothing, getting in and out of the tub or shower, wetting, soaping, and rinsing skin, shampooing … activities with garment closures (e.g., zippers, buttons) at the back of the garment. Typical clothing changes are from sleepwear to daywear and from daywear to sleepwear. Upper Body Upper … is able to dress the upper body without assistance or is able to dress him- or herself if clothing is laid out or handed to him or her. B. Member is able to dress the upper body by him- … -
General Pediatric Clinic - 3 to 4 Week Visit
… Eye Contact Smiles Responsively Smiles Spontaneously Anticipatory Guidance: Clothing, breathing, crying, outings, look for response to noise. Holding baby: Mom knows or … will adjust after a few days and the baby will be back on schedule. Anticipatory Guidance Clothing — Basic cotton shirt and diaper, add as necessary. Most babies don’t need more clothes … than average adult. Find out by feeling baby’s body, it should be warm but not hot. No tight clothing with long strings, cover hands and feet, especially if the baby scratches. Allow room to … -
Divestment Penalty and Undue Hardship Notice Plus Waiver Request, Spanish
… penalty period will endanger your health or life or how you will not be able to get food, clothing, shelter, or other necessities of life: Attach a separate piece of paper if you need … -
Prenatal Care Coordination Care Coordinator Visit Checklist
… and infant car safety |_| |_| |_| |_| |_| |_| |_| Referrals for Resources Basic Needs (Food, Clothing, Housing) Make sure member has access to appropriate food, clothing, and housing, and provide referrals if necessary |_| |_| |_| |_| |_| |_| |_| … -
General Pediatric Clinic - 6 to 8 Week Visit
… will adjust after a few days and the baby will be back on schedule. Anticipatory Guidance Clothing — Basic cotton shirt and diaper, add as necessary. Most babies don't need more clothes … than average adult. Find out by feeling baby's body, it should be warm but not hot. No tight clothing with long strings, cover hands and feet, especially if the baby scratches. Allow room to … -
General Pediatric Clinic - 6 to 8 Week Visit
… will adjust after a few days and the baby will be back on schedule. Anticipatory Guidance Clothing — Basic cotton shirt and diaper, add as necessary. Most babies don't need more clothes … than average adult. Find out by feeling baby's body, it should be warm but not hot. No tight clothing with long strings, cover hands and feet, especially if the baby scratches. Allow room to … -
Wisconsin Medicaid Spousal Impoverishment Protection
… insurance, some amounts in irrevocable burial trusts, and plots). • Household items. • Clothing and other personal items. Reducing Assets to the Allowable Limit Excess assets are … or for other things, such as home repairs or improvements, vehicle repair or replacement, clothing, or other household expenses. If excess assets are not reduced, the 3 spouse who needs … -
General Pediatric Clinic - 15 Month Visit
… Points to a named part of the body P.S. Removes a piece of clothing SIGNATURE — Provider Date Signed Drinks from a cup alone … -
General Pediatric Clinic - 18 Month Visit
… Gives a toy to the mother P.S. Removes own clothing SIGNATURE — Provider Date Signed Imitates simple housework …