ATTN: Florida Facilities: Form AHCA 5000-3008 has been revised

The Medical Certification for Nursing Facility/Home and Community-Based Services form (AHCA MedServ-3008 form, May 2009), commonly known as the 3008, has been revised and incorporated into Rule 59G-1.045, Florida Administrative Code. In addition to extensive updates to the form itself, the 3008 has a new name and a new form number. The revised 3008 is called the Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form (AHCA Form 5000-3008, October 2015). Use of the AHCA MedServ-3008 should have been discontinued on October 1. Effective October 1, the AHCA Form 5000-3008 replaces the AHCA MedServ-3008. The revised 3008 is available on the Department of Elder Affairs’ web page (http://elderaffairs.state. and on the Florida Medicaid Web Portal Provider Forms ( ProviderSupport_Forms/tabId/52/Default.aspx) webpage.