| STEPS | Fillable Form (create same way as the MDS intake hit "save as Draft" share link with Rn/Cm/ whoever to finish) | Enrollment Link 🔗 Below | Required by State? (Y/N) | Signer(s) | Destination |
|---|---|---|---|---|---|
| #1 | Member’s Initial Intake Form (fill this out if you agree to join our agency) | Initial Intake (Fillout V3) | Y | Member/ Caregiver | Received inZoho Desk Ticket 🎫 |
| #2 | Caregiver Enrollment + Member Release of Medical Records | Caregiver + Backup Caregiver Must Fill out | Y | Member/ Caregiver | Received inZoho Desk Ticket 🎫 |
| #3 if Agree want to Switch to CCA | CCA referral -Clare only accepts Masshealth Standards & CCA SCO /OneCare | Fillable/Sign CCA refer | Y | Member | Folder |
| #4 | IF Senior is a WAIVER (FEW ) We Need | FEW Waiver Form blank | Y | RN | Member Project Document area |
https://claremissionapplicationform.fillout.com/InitialIntakeform