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Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form
AHCA 5000-3008 (JUN 2016)

The AHCA 5000­3008 form is used by the Comprehensive Assessment and Review for Long­Term Care Services (CARES) Program to determine medical eligibility for Medicaid Waiver programs. This form must be signed by a Florida­licensed physician, physician assistant, or Florida­licensed advanced registered nurse practitioner, and returned to the local CARES Office (refer to the CARES Map to find the appropriate office).


As of July 11, 2016, the CARES Program shall only accept the revised Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form ‚Äď AHCA 5000-3008 (JUN 2016), as incorporated into Rule 59G-1.045, Florida Administrative Code.

Click below to download the form:
Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form - AHCA 5000-3008 (JUN 2016)


Additional Information for Nursing Facilities and Hospitals when submitting a 3008 to CARES on behalf of a client:



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