Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona

Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona

What Is Form DDD-2099A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DDD-2099A?
A: Form DDD-2099A is a document related to Electronic Visit Verification (EVV) Member Contingency/Back-Up Plan.

Q: What is Electronic Visit Verification (EVV)?
A: Electronic Visit Verification (EVV) is a system that electronically verifies the delivery of services by home care providers.

Q: What is the purpose of Form DDD-2099A?
A: The purpose of Form DDD-2099A is to outline a contingency/back-up plan for members receiving services through EVV.

Q: Who uses Form DDD-2099A?
A: Form DDD-2099A is used by members receiving services through EVV in Arizona.

Q: What does the form include?
A: The form includes information about the member's preferred method of contact, backup caregiver information, and emergency contact details.

Q: Why is a contingency/back-up plan important for EVV?
A: A contingency/back-up plan ensures that services can still be provided in case of any issues with the primary caregiver or the EVV system.

ADVERTISEMENT

Form Details:

  • Released on September 1, 2021;
  • The latest edition provided by the Arizona Department of Economic Security;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DDD-2099A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

Download Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona

4.6 of 5 (25 votes)
  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency/Back-Up Plan - Arizona

    1

  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency/Back-Up Plan - Arizona, Page 2

    2

  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency/Back-Up Plan - Arizona, Page 3

    3

  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona, Page 1
  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona, Page 2
  • Form DDD-2099A Electronic Visit Verification (Evv) Member Contingency / Back-Up Plan - Arizona, Page 3
Prev 1 2 3 Next
ADVERTISEMENT