Family MO HealthNet (MAGI)

1802.020.35 Signing By a Relative

IM-#134, November 14, 2017

If the applicant is not capable of signing an application, due to physical or mental impairment, a relative who meets criteria shown in manual section 1802.020.00 Signing the Application may sign the application. Inform the relative that the applicant is responsible to ensure complete and correct information is provided on the application. Signatures for applications signed by relatives should be in the following format: (applicant first and last name) by (relative first and last name), (relationship)

EXAMPLE:Mary Jones is the mother of Jane Jones who is pregnant.  Jane has signed the portion of the application giving her mother permission to be her authorized representative.      Mary should sign the application as follows –                  Jane Jones by Mary Jones, mother of Jane.

NOTE:The designation of an authorized representative on the IM-1SSL or completed Appointment of Authorized Representative (IM6-AR) form must be signed by the applicant. Relatives cannot appoint an authorized representative on behalf of an applicant.