Updates to forms DHS-3427 LTC Screening Document, DHS-3428 LTCC Assessment, DHS-3428A LTCC Assessment Social Work Section

Minnesota Department of Human Services
Aging & Adult Services Division - Community Supports for Seniors E-list

September 19, 2016

E-list archive


The Aging and Adult Services Division staff updated three forms that are now on eDocs.

LTC Screening Document – DHS3427 version 9-16

  • Value 11 in the Legal Representative Status field was changed from Health Conservator to Health Care Agent.  You will see this new name on the MMIS screen whenever you use value 11.

Minnesota Long Term Care Consultation Service Assessment Form – DHS-3428 version 9-16

  • Value 11 in the Legal Representative Status field was changed from Health Conservator to Health Care Agent. 
  • Added the Citizenship field for Alernative Care and Essential Community Supports programs.  This is item L.8 and will merge to the LTC screening document.

Minnesota Long-Term Care Consultation Service Assessment Form: SW Section – DHS 3428A version 9-16

  • Value 11 in the Legal Representative Status field was changed from Health Conservator to Health Care Agent. 
  • Added the Citizenship field for Alernative Care and Essential Community Supports programs.  This is item I.8 and will merge to the LTC screening document.

 

Please download and use these new versions.  Thank you!

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