64F-19.003. Certification and Authorization

Effective on Sunday, February 17, 2008

1(1) Waiver applicants shall give written consent before the CHD can obtain or authorize the release of financial and medical information for the purpose of determining Program eligibility. Eligibility information will be obtained by filling out form DOH 3212 as referenced in Rule 4464F-19.011, 45F.A.C.

46(2) Signed consent forms of eligibility for DOH 3212, as referenced in Rule 5964F-19.011, 60F.A.C., must be kept in an administrative file at the CHD that enrolled the client in the Program for a minimum of six (6) years.

85Rulemaking Authority 87154.011, 88381.0011(13), 89381.0051(7) FS. 91Law Implemented 93154.011, 94381.0051 FS. 96History–New 8-9-04, Amended 2-17-08.

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