How to Complete the DHS-390 Form 📝

Hi, my name is Ansh, and I'm one of the owners at Cova Home Care!

This video walks you through filling out the DHS390 form, and it's one of the applications to help you start the Home Help Program in Michigan.

It should take a couple of minutes.

And you'll be filling this out on behalf of the patient, so make sure you have their details ready.

To start, We're going to skip section one.

You should ignore everything there.

The whole box is marked for departmental use, so it's not for you to sign.

And then we begin with section two.

We have to fill in seven things over here about the patient, starting with their full legal name, the date of birth, the Medicaid ID, which you can find at the front of their Medicaid card, the full street address, city, state and zip code, as well as their phone number and email address.

If you know that the patient isn't really on their phone, or if they don't have an email address, you're more than welcome to put your own one there as well.

We're going to go on to section three.

And over here you should tick box one, which is the home help box.

You should leave the other two alone.

You then go on to section four.

And there's two parts to section four.

Part one asks about the patient's status.

You should tick every box that applies to them.

For now, you should only tick box 1A.

But if you see things like SSI, Food Assistance, or Veteran Affairs, for example, you can click that, too.

More than one box is fine.

Section two, it's all about the patient's living arrangement.

And, you should tick every box that applies to the patient, such as whether they live alone, with a spouse.

And if they do live with a spouse, you should tick, the boxes below as well.

Do they live with children?

And if so, you also need to write down how many.

Whether they live with others.

And as you can see, I've clicked on living with others, as well as living with two other people in the same household.

Whether they live in a hospital or nursing home.

You should be clicking no here.

Do they have a legal guardian?

If so, you can write yes and also identify the name of their guardian.

And you can also click yes to whether a caregiver has already been identified.

Then, at the bottom of that page, you go ahead and sign.

The patient should be signing this over here, unless you are the legal guardian of that patient, by which you can also sign this over here and make sure the date's right there at the bottom as well.

That's all there is to this form.

And once you're done, please take a photo of each and every page and send that back to us at our phone number.

734-707-7330.

Thank you!