135.311 Obtaining Verification For Medical Exemption

The CAO will:

1. Complete the CAO address, case record identification information and the individual’s contact information on the top of page one of the PA 635 .

2. Indicate a return date of no more than 30 days from the date indicated on the form.

NOTE: If the individual has not yet established a medical exemption, and you have granted good cause 53 to have the PA 635 completed, ensure the return date on the form coincides with the good cause review date entered in eCIS. See Section 135.4, Good Cause .

3 . Indicate the required participation hours for this individual in Section II.

4 . Instruct the individual to take the PA 635 to their medical provider.

5 . Have the individual sign an Authorization for Use or Disclosure of Personal Information ( HS 1815 ) to accompany the PA 635 .

6. Provide a stamped envelope addressed to the CAO for the physician’s office to return the completed form within 30 days from the date indicated on the form.

NOTE: The medical provider may return the completed form to the CAO via mail, secure email, or secure fax. The PA 635 may only be emailed to the CAO if the sender has a DHS-secured CWOPA email account.

An individual is considered mandatory for RESET if they fail to verify exempt status within 30 days of the date indicated on the form, unless the individual has cooperated and verification is pending from a third party.