Free New Hampshire 3820 PDF Form

The New Hampshire 3820 form serves as a crucial tool for managing the transitions of residents within long-term care facilities, specifically in nursing homes and community-based programs. Designed by the Bureau of Elderly & Adult Services, this form facilitates the notification process for changes in status, whether it be a transfer, discharge, or other significant updates concerning a resident's care. It captures essential details such as the resident's name, Medicaid ID number, and the facilities involved in the transition. Additionally, the form records vital dates, including the start and stop dates of Medicare, as well as actual and anticipated discharge dates. For those transitioning back to community living, the form also requires information about the community address and contact details. By ensuring that all necessary information is documented and communicated effectively, the New Hampshire 3820 form plays a pivotal role in safeguarding the continuity of care for individuals in long-term care settings.