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medical releases, those should be sent to DDB. If the applicant was able to sign the releases only with an "X” or other mark, two witness signatures are needed on the release form. 4. Documentation of guardianship or power of attorney should be included if medical releases are signed by a guardian or person with power of attorney. The IM worker should complete the MADA form as thoroughly as possible, including: 1. Name, address, and phone number of next of kin, friend, or other person initiating the Medicaid application on the decedent’s behalf (Section I). 2. The date on which the applicant became unable to work (Section I, number 2). 3. Contact information for medical sources treating the applicant prior to and at time of death (Section III). If Medicaid coverage is needed for less than three full months prior to application the IM worker should include a statement regarding the necessary coverage dates in Part VI of the MADA. For example, when the applicant died shortly after an accident or start of illness and coverage is needed only for brief medical care and/or burial expenses. 5.3.2 Agency Form Processing See Process Help Section 12.13 Automated Medicaid Disability Determination. When completed MADA forms are received by the local agency, the IM worker must: Determine if the applicant meets all other Medicaid eligibility requirements, with the exception of the disability determination and income. Do not send the MADA to DDB if the applicant does not meet all other Medicaid eligibility requirements aside from disability and income, with one exception: If a non-qualifying immigrant would qualify for Emergency Services Medicaid only if he or she was disabled, send the MADA to DDB. 5.3.3 Release Form Ask the applicant to sign a Confidential Information Release Authorization to Disclose Information to Disability Determination Bureau (DDB) form, F-14014. This is the only form DDB can accept. See Process Help Section 12.13 Automated Medicaid Disability Determination. Applications for disability made by the applicant must include releases that are signed personally by the disabled applicant. Applications made on behalf of a disabled applicant must be accompanied by release forms signed by a legally appointed representative. A copy of the court order appointing a representative must be included with the application. An authorized representative’s signature on the release is not acceptable unless he or she has a court order. 5.3.4 Medical Report If the applicant has copies of any medical records, school records, etc., include them with the application. A medical report of disability does not need to be submitted with the application. DDB will obtain all of the medical reports necessary for the disability determination. However, if the applicant or the representative has already provided medical records/reports to the IM agency, this evidence must be scanned into the ECF along with the completed MADA form.