Documents Needed to Apply for Personal Care Services:
Please click on the link below to download and print out the forms. Upon completion, please contact us by clicking here should you have additional questions.- 1. Medical Request for Home Care
- This form, also know as M11Q, must be completed by your primary care physician. The form is valid for up to thirty days. That means at the time of submission, this form must not be dated over thirty days old.
- 2. Attestation of Immediate Need
- This form is used to demonstrate or certify that you need an expedited processing of your application. In general, completing and submitting this form places your application in a priority manner.
- 3. Authorization for Release of Health Information Pursuant to HIPPA Form
- As the name of the form suggests, this is a privacy release consent form.
Below is a flowchart outlining the steps involved in applying for PCS service:
