Medical Eligibility Determination (MED) Tool (V 8.0)

• Medical Eligibility Determination Form (Adobe PDF*)- This is the entire form, including Background information, Clinical Detail, Scoring Sheet/Eligibility Determination, Careplan and Outcome.
• Manual (Adobe PDF*) (Microsoft Word*) - Instructions for completing the Medical Eligibility Determination Form
• Below are the individual components in separate PDF files.
• Referral Form (PDF*)
  • Referral Form Instructions (PDF*)
  • Background Information (PDF*)
  • Clinical Detail (PDF*)
  • Scoring Sheet/Eligibility (PDF*)
  • Coding Sheet (PDF*)
• MEDXX Version 3 Use Memo - July 11, 2001 (Word*) (PDF*)
• Version 3 Change Notes - July 11, 2001 (Word*) (PDF*)