SUBJECT:
DA-124 A/B, DA-124C, AND DA-124C (ATT) AVAILABLE ONLINE
DISCUSSION:
The DA-124 A/B, DA-124C, and DA-124C (ATT) can now be accessed online from the Division of Health and Senior Services website. The forms may be completed online, printed, signed, and then mailed to the Central Office Medical Review Unit (COMRU) for processing.
The forms can be accessed at www.dhss.mo.gov. From the menu on the left side of the screen, click the link titled “Applications and Forms.” This takes you to a screen which displays a listing of available forms. The DA-124 forms are about halfway down the page. The forms are labeled as Initial Assessment -Social and Medical (DA-124 A/B); Level One Nursing Facility Pre-Admission Screening DA-124C; and Notice to Applicant (DA-124C ATT). Click the corresponding link for the form you wish to access.
When counties are contacted by nursing care facility staff, inform them that these forms may be accessed online. Facility staff may complete, print, sign, and mail the form(s) to COMRU for processing.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Inform nursing facilities of the availability of these forms online.