Completing the “Medical Certification for Nursing Facility/
Home- and Community Based-Services form”
(AHCA MedServ-3008 form)
- Download the Medical Certification for Nursing Facility/Home- and Community Based-Services form (AHCA MedServ-3008 form). revised May 2009 (PDF)
This form must be completed and signed by a licensed physician and returned to the local CARES office. This form is used by CARES to determine medical eligibility for Medicaid Waiver programs.
- View the CARES Map for contact information including mailing address and fax numbers for all 19 CARES offices.
- View detailed instructions on completing the Medical Certification for Nursing Facility/Home- and Community-Based Services form. updated May 2009 (PDF)
Additional Information for Nursing Facilities and Hospitals when submitting a 3008 to CARES on behalf of a client:
Additional Information for CARES office staff use:
For questions concerning this page, please contact Pia Neustadter by email at firstname.lastname@example.org or by phone at (850) 414-2000.
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