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DATE: Oct. 5, 2016
TO: Lead agency staff who do long-term care (LTC) screenings and long-term
care consultation (LTCC) assessments
FROM: DHS Disability Services Division
EFFECTIVE: Immediately
PURPOSE OF ELIST: To notify lead agencies that DHS updated forms DHS-3427, DHS-3428 and
DHS-3428A
CONTACT: DSD.ResponseCenter@state.mn.us
DHS
updated the following forms:
Please
download and use these new versions. We
will update MnCHOICES to
align with these changes.
LTC
Screening Document, DHS-3427
In the LTC Screening
Document, DHS-3427 (PDF), DHS made the following change:
- On
page one, under the options to complete field 15 “legal rep. status,” changed value
11 from “health conservator” to “health care agent.”
You will see
this new name on the MMIS screen whenever you use value 11.
Minnesota LTCC
Services Assessment Form, DHS-3428
In the Minnesota
LTCC Services Assessment Form, DHS-3428 (PDF), DHS made the following
changes:
- On page three, under the options to complete Ba.20 “legal representative status,” changed value 11 from “health conservator” to “health care agent.
- On page 31, in the Alternative Care and Essential Community Supports section, added the citizenship field (L.8). This item will merge with the LTC Screening Document, DHS-3427.
Minnesota LTCC
Services Assessment Form: SW Section, DHS-3428A
In the Minnesota
LTCC Services Assessment Form: SW Section, DHS-3428A (PDF), DHS made the
following changes:
- On
page three, under the options to complete Ba.20 “legal representative status,”
changed value 11 from “health conservator” to “health care agent.”
- On
page 17, under the Alternative Care and Essential Community Supports section,
added the citizenship field (I.8). This item will merge with the LTC Screening
Document, DHS-3427.
Visit CBSM — What's new often for a list of policies/pages we've recently updated in the DSD Community-Based Services Manual.
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