Form DHS-6189C-ENG Adult Companion Services or Individualized Home Supports Without Training Provider Assurance Statement - Minnesota Health Care Programs (Mhcp) - Minnesota

Form DHS-6189C-ENG Adult Companion Services or Individualized Home Supports Without Training Provider Assurance Statement - Minnesota Health Care Programs (Mhcp) - Minnesota

What Is Form DHS-6189C-ENG?

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

FAQ

Q: What is DHS-6189C-ENG?
A: DHS-6189C-ENG is a form for Adult Companion Services or Individualized Home Supports Without Training Provider Assurance Statement.

Q: What are Adult Companion Services?
A: Adult Companion Services are non-medical care and supervision provided to adults with disabilities or seniors to promote independence and enhance quality of life.

Q: What are Individualized Home Supports Without Training?
A: Individualized Home Supports Without Training are non-medical assistance provided in a person's home to help with daily activities and tasks.

Q: Who needs to fill out this form?
A: Providers of Adult Companion Services or Individualized Home Supports Without Training in the Minnesota Health Care Programs (MHCP) need to fill out this form.

Q: What is the purpose of this form?
A: This form serves as an assurance statement for providers to demonstrate compliance with the requirements of the Minnesota Health Care Programs.

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Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the Minnesota Department of Human Services;
  • 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 DHS-6189C-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

Download Form DHS-6189C-ENG Adult Companion Services or Individualized Home Supports Without Training Provider Assurance Statement - Minnesota Health Care Programs (Mhcp) - Minnesota

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