GUIDE Eligibility Check – CMS Dementia Care Model

Confidential Health Screening for EmpowerMe Medical Group, P.C., an Approved CMS GUIDE Participant.

This screening form is used solely to determine potential eligibility for the CMS GUIDE Model. It does not determine Medicare coverage or enrollment. All information is protected under HIPAA and reviewed only by EmpowerMe Medical Group, P.C., Continuum (an approved GUIDE Partner Organization), and Crosby Health.