Check the change of status type: transfer between nursing facility or waiver services (NF to CFI), or other change of status (specify).
Still required: the individuals history and physical, therapy notes, transition plan, plan of care and nursing assessments are still required.
Where to send: upload completed forms to www.NHEASY.nh.gov or fax a copy to BAAS, Attn: LTC Medical Eligibility Unit at 603-271-7985.
Programs: check which program(s) or service(s) the recipient was receiving prior to admission: CFI Program or Other Waiver Programs (Specify).
| Question | Answer |
|---|---|
| Form Name | BAAS 3820 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 51 |
| Avg. time to fill out | 9 min |
| Edition | Rev 11/25 |
| Issuing agency | NH Department of Health and Human Services |
| Where to send | Upload to www.NHEASY.nh.gov or fax to BAAS, Attn: LTC Medical Eligibility Unit |
| Other names | BAAS 3820, BAAS-3820, 3820, NH 3820, Change Of Nursing Facility Status |
| Official source | BAAS 3820 (Rev 11/25), NH Department of Health and Human Services |
New Hampshire Form 3820 isn’t the one you’re looking for?