This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Tagalog. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the purpose of Form MC604 MDV TAG Doctor's Verification?
A: The purpose of Form MC604 MDV TAG Doctor's Verification is to verify the need for home and community-based services under spousal impoverishment provisions.
Q: Who is this form for?
A: This form is for individuals in California who are seeking home and community-based services under spousal impoverishment provisions.
Q: What does the form verify?
A: The form verifies the need for home and community-based services.
Q: What are spousal impoverishment provisions?
A: Spousal impoverishment provisions are rules that aim to prevent the spouse of a Medicaid recipient from becoming impoverished when seeking long-term care services.
Q: Is this form specific to a certain language?
A: Yes, this form is available in Tagalog, a language commonly spoken in the Philippines.
Form Details:
Download a printable version of Form MC604 MDV TAG by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.