IA DHS 470-4389 2009-2025 free printable template

Provider s Signature 470-4389 Rev. 11/09 N2 Bathing grooming personal hygiene N3 Meal preparation feeding N6 Essential housekeeping N7 Minor wound care N10 Communication N11 Essential transportation S2 Intravenous therapy assistance S3 Parenteral injections S6 Care of decubiti and other areas S7 Rehabilitation services S10 Post-surgical nurse delegated activities S11 Monitoring reactions to medication S13 Recording and reporting of changes in vital signs to the nurse or therapist...

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How to fill out IA DHS 470-4389

1. Start by downloading the IA DHS 470-4389 form from the official Iowa DHS website.
2. Fill in your personal information including your name, address, and contact details in the designated sections.
3. Provide details about your household members, including their names, ages, and relationship to you.
4. Indicate your income sources by including details of your employment, benefits, or any other income received.
5. Complete the expense section by listing any relevant monthly expenses, such as rent, utilities, and childcare.
6. Review all provided information for accuracy and completeness.
7. Sign and date the form at the bottom to certify that the information is truthful.
8. Submit the completed form to the appropriate DHS office as directed.

Who needs IA DHS 470-4389?

1. Individuals or families who are applying for or receiving assistance from the Iowa Department of Human Services and need to report changes in their situation.

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People Also Ask about daily service record

What is the monthly income limit for Medicaid in Iowa?

Income & Asset Limits for Eligibility 2023 Iowa Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (one spouse applying)Medicaid Waivers / Home and Community Based Services$2,742 / month$2,742 / month for applicantRegular Medicaid / Aged Blind and Disabled$914 / month$1,371 / month2 more rows • Dec 19, 2022

What does Medicaid pay for Iowa?

Eligibility is based on household income. Coverage plan benefits for all Iowa Health and Wellness Plan members include doctor visits, prescription drug coverage, dental care, preventive health services, emergency care, mental health services, hospitalizations, and more.

How do I get my Medicaid number in Iowa?

Questions on Medicaid and Applying for Health Care Coverage: If you're looking for information about health care coverage options and how to apply for Medicaid, call the Department of Human Services Contact Center toll-free at 1-855-889-7985, Monday-Friday, 7:00 a.m.- 6:00 p.m.

How do I look up Medicaid in Iowa?

Call our toll-free Provider Services number at 833-404-1061 from any touch-tone phone and follow the appropriate menu options to reach our automated member eligibility-verification system 24 hours a day. The automated system will prompt you to enter the member Medicaid ID and the month of service to check eligibility.

How long does it take to get approved for Medicaid in Iowa?

Generally, if your provider provides all information to Iowa Medicaid the timeframe is generally 10-15 business days.

What is Medicaid called in Iowa?

Hawki: Healthy and Well Kids in Iowa (Hawki) provides health care coverage for children of working families. No family pays more than $40 per month and some families pay no premiums. Dental-only coverage is also available under Hawki for children whose families have health insurance but not dental insurance.

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What is IA DHS 470-4389?

IA DHS 470-4389 is a form used by the Iowa Department of Human Services for the application and verification of certain benefits or services.

Who is required to file IA DHS 470-4389?

Individuals or families applying for specific assistance programs through the Iowa Department of Human Services are required to file IA DHS 470-4389.

How to fill out IA DHS 470-4389?

To fill out IA DHS 470-4389, applicants should provide accurate personal information, financial details, and any other required documentation as specified in the form's instructions.

What is the purpose of IA DHS 470-4389?

The purpose of IA DHS 470-4389 is to collect information necessary for determining eligibility for state assistance programs.

What information must be reported on IA DHS 470-4389?

IA DHS 470-4389 requires reporting personal identification information, household income, expenses, and details about any other assistance the applicant may be receiving.