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KENTUCKY BOARD OF NURSING SUMMARY OF MAJOR ACTIONS Regular Board Meeting December 9 and 10, 2004 ANNUAL LICENSURE RENEWAL FEE Ratified the annual licensure renewal
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Commonwealth of Kentucky Cabinet for Health and Family Services Department for Medicaid Services WAIVER SERVICES PHYSICIAN’S RECOMMENDATION
Map 10 (Rev 08/14)
PLEASE RETURN TO THE REQUESTOR LISTED BELOW. ___________________________________________________________________________________ (Requestor’s Name)
DIAGNOSIS (ES): _____________________________________________________________________________________ Recommended Waiver Program: HCBW (APRN, PA or Physician signature) ABI Waiver – Services to adults with acquired brain injury (18 yrs and older) with a potential for rehabilitation and retraining (Physician signature) ABI Long Term Care Waiver – Services to adults (18 yrs and older) with acquired brain injury who have reached a plateau in their rehabilitation level and require maintenance services. (Physician signature) SCL Waiver (SCL IDP or Physician signature) Michelle P. Waiver – Non-residential Services to children and adults with intellectual or developmental disabilities. (APRN, IDP, PA or Physician signature)
I certify that if Waiver services were not available, institutional placement in a Nursing Facility (NF) or Intermediate Care Facility for the Intellectual/Developmentally Disabled shall be appropriate for this member.