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Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form
AHCA 5000-3008 (October 2015)

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


As of October 1, 2015, the CARES Program shall only accept the revised Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form – AHCA 5000-3008 (October 2015), 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 (October 2015)


View instructional form for assistance completing the Medicaid Long-Term Care Services and Patient Transfer Form:


View PowerPoint “How to Properly Complete the New AHCA 5000-3008 Form”.


Medical Certification for Medicaid Long-term Care Services and Patient Transfer Form (AHCA Form 5000-3008, October 2015) Frequently Asked Questions.

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



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