DSHS Form 10-643 Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) - Washington

What Is DSHS Form 10-643?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 10-643?
A: DSHS Form 10-643 is a form used for requesting skilled nursing in a community setting in Washington.

Q: What is the purpose of DSHS Form 10-643?
A: The purpose of DSHS Form 10-643 is to conduct a pre-admission screening and resident review for skilled nursing services in a community setting.

Q: Who needs to fill out DSHS Form 10-643?
A: The form needs to be filled out by individuals or their representatives who are seeking skilled nursing services in a community setting.

Q: What information is required on DSHS Form 10-643?
A: The form requires information about the individual's medical condition, current care needs, and any existing services or supports.

Q: When should DSHS Form 10-643 be submitted?
A: The form should be submitted prior to admission to a skilled nursing facility in a community setting.

Q: Is there a fee for submitting DSHS Form 10-643?
A: No, there is no fee for submitting the form.

Q: Who can help with completing DSHS Form 10-643?
A: You can seek assistance from a healthcare professional, social worker, or case manager to help you complete the form.

Q: What happens after DSHS Form 10-643 is submitted?
A: After the form is submitted, a pre-admission screening will be conducted to determine eligibility for skilled nursing services in a community setting.

Q: What if my request for skilled nursing in a community setting is denied?
A: If your request is denied, you have the right to appeal the decision and seek further assistance and clarification from DSHS.