Form H1278, Request for Patient Trust Fund Information

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Effective Date

8/1992

h1278.pdf

Instructions

Updated: 3/1993

Purpose

Form H1278 is an optional form to gather information about a client's patient trust fund.

Procedure

When to Prepare

The eligibility specialist can use Form H1278 for applications and reviews.

Number of Copies

Prepare one copy.

Transmittal

Send the form to the nursing facility.

Form Retention

Keep the form according to the retention requirements of the case record.

Detailed Instructions

Self-explanatory.