DHS 1147 Level of Care and At Risk Evaluation Instructions (Rev. 06/2023) .

Click the links below to access and print the most-current evaluation forms and instructions approved by the Med-QUEST Division: DHS/MQD Form 1147 (Revised 12/11/2025)

This document provides detailed instructions for filling out the DHS Form 1147, used for Level of Care and At Risk evaluation. It includes step-by-step guidance on the necessary information …

The document provides detailed instructions for completing the DHS Form 1147, which is used for Level of Care (LOC) and At Risk evaluations.

Filling out the DHS 1147 form online can simplify the process of submitting essential information for level of care and at-risk evaluation. This guide will walk you through each section of the …

THIS IS NOT AN AUTHORIZATION FOR PAYMENT OR APPROVAL OF CHARGES. PAYMENT BY THE MEDICAID PROGRAM IS CONTINGENT ON THE INDIVIDUAL BEING ELIGIBLE, …

Use a 1147 instructions form 2014 template to make your document workflow more streamlined. The 1147 instructions form is a crucial document used primarily for the evaluation of care …

Enter the name, title and telephone, fax number and email address of the assessor. The assessor must sign the form.

DHS 1147 Instructions refer to the guidelines provided by the Department of Homeland Security for completing the DHS 1147 form, which is used for specific applications related to …

Complete a functional status assessment on the 1147 more accurately. Learn tips on meeting Skilled Nursing Facility (SNF) criteria for common SNF qualifiers. Learn how to submit …