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Medical Eligibility Determination (MED) Tool   V 8.0 (3/01/2007)

These are Adobe PDF versions of the Medical Eligibility Determination (MED) Form. If you do not have Adobe Acrobat installed on your PC, click on the link below to download it from the Adobe site. If you cannot view Adobe files, you may E-mail the Office and request a printed copy.

Medical Eligibility
Determination Form 		This is the entire form, including Background information, Clinical Detail, Scoring Sheet/Eligibility Determination, Careplan and Outcome. Below are the individual components in separate PDF files.
   Referral Form

Pick from the links to the left for
individual components of the MED form.

   Referral Form Instructions
   Background Information
   Clinical Detail
   Scoring Sheet/Eligibility
   Coding Sheet
   Care Plan
   Outcome
   Community Options
Manual (PDF format)
Manual (MS Word format) 		Instructions for completing the Medical Eligibility Determination Form
Topic Date WEB Version Word 2000 Version Adobe PDF Version
MEDXX Version 3 Use Memo July 11, 2001 MedXX Use Memo- HTML Version MedXX Use Memo - Word Version MedXX Use Memo - PDF Version
Version 3 Change Notes July 11, 2001 Version 3 Change Notes - HTML Version Version 3 Change Notes - Word Version [PDF Icon]
Get Adobe Acrobat
(If you don't have Adobe Acrobat)