Forms: ABCDM-83 (08MA083E)

Notification Regarding a Patient in a Long Term Care (LTC) Facility

Skilled, nursing, and intermediate care for the intellectually disabled facility operators use this form to notify the Oklahoma Department of Human Services (DHS) each time a patient approved for SoonerCare (Medicaid) LTC benefits is admitted to or discharged from the facility, and when a patient wants to make a LTC application. This form is submitted within five calendar days of admission or discharge.

Form ABCDM-83 (08MA083E)

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