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*)
- Care Plan (PDF*)
- Outcome (PDF*)
- Community Option (PDF*)
MEDXX Version 3 Use Memo - July 11, 2001 (Word*) (PDF*)
Version 3 Change Notes - July 11, 2001 (Word*) (PDF*)