This document provides detailed instructions for completing the Health and Functional Assessment (HFA) for children and adults in Hawaii, including guidelines for Long Term Services and Supports (LTSS) and Special Health Care Needs (SHCN).

This is a 21-page form used for assessing the health and functional needs of children and adults in Hawaii, including long-term services, special health care needs, and at-risk individuals.

A sample of the CMS 1500 Health Insurance Claim Form (02-12 version) used for submitting medical claims to insurance providers.

This form is for physicians to request emergency processing of a Med-QUEST application for patients needing urgent medical assistance.

Instructions for completing the DHS 1149 form, used to request emergency processing for medical assistance applications.

Form DHS 1149A is used by hospital or facility staff to document emergency medical assistance for non-citizens and non-residents in Hawaii. It includes sections for hospital staff and medical consultants to complete.

This document provides instructions for completing and submitting the DHS 1149A form, used to request emergency medical assistance for non-citizens and non-residents.

This form is used to request and authorize the level of care for individuals with developmental or intellectual disabilities in an Intermediate Care Facility (ICF-DD/ID).

Instructions for completing the DHS 1150C form, used to authorize Intermediate Care Facility services for individuals with developmental or intellectual disabilities.

This form is used for referring applicants or beneficiaries to the ADRC for determination or re-determination of eligibility for services. It includes sections for referral details, attached documents, and determination outcomes.

This form is used for referring applicants or beneficiaries to the ADRC for initial determination or re-determination of eligibility, including SHOTT applications and disability evaluations.

This document provides instructions for completing the DHS 1180 form, used for Aging and Disability Resource Center referrals and determinations or re-determinations.

Instructions for completing the DHS 1188 form, used by Med-QUEST Division trading partners to access the Electronic File Transfer (EFT) server for data exchange.

This form is used to request, modify, or terminate access to electronic data exchange with the Hawaii Med-QUEST Division. It includes sections for user and trading partner information, data exchange types, and affirmation requirements.

Form DHS 1188 is used to request, modify, or terminate access to Med-QUEST Division electronic data exchange systems. It includes sections for user and entity information, data exchange types, and affirmation statements.