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Family and Social Services Administration

Aging Home > Forms > Electronic Form 450B Electronic Form 450B

As of January 1, 2013, nursing facilities may submit Physician Certification for Long-Term Care Services (Form 450B) and associated supporting paperwork electronically. 

As of February 1, 2013, electronic submission will be mandatory, and paper submissions will no longer be accepted.  Any paper submission will be returned to the nursing facility that submitted it with a notice to file it electronically.

To file an electronic Form 450B, please click this link.