Va. Admin. Code tit. 12, agency 30, ch. 130, pt. XX, form FORMS (12VAC30-130)
Current through Register Vol. 41, No. 10, December 30, 2024
Forms accompanying Part II of this chapter:
Virginia Uniform Assessment Instrument (eff. 1994)
Forms accompanying Part III of this chapter:
MI/IDD Supplement, DMAS-95, Level I PASRR Form and Instructions (rev 4/2019)
MI/IDD/Related Conditions Supplement Level II, DMAS-95 MI/IDD/RC Supplement (rev. 12/2015)
Forms accompanying Part VII of this chapter:
Request for Hospice Benefits, DMAS-420 (rev. 9/2019)
Forms accompanying Part IX of this chapter:
Patient Information Form Medicaid LTC Communication Form, DMAS-122, 225 (eff. 10/2011)
Va. Admin. Code tit. 12, agency 30, ch. 130, pt. XX, form FORMS (12VAC30-130)
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.