Florida's CARES program uses this form to decide whether a person applying for Medicaid nursing facility care (the Institutional Care Program) or a home and community-based services waiver meets medical eligibility. It doubles as an optional hospital-to-facility patient transfer form. A physician, ARNP or PA certifies the need for nursing facility or waiver services, and CARES cannot accept forms with starred items missing.
Staff working with the signing professional may fill in the form and list their name in Section Z. Section Y must be signed by a Florida-licensed physician, by an ARNP within scope of practice, or by a PA delegated by the supervising physician.
Patient name, last 4 SSN digits and date of birth are required at the top of both pages. Section A records gender, Hispanic ethnicity, race and primary language. Section B notes visual and hearing impairments, including hearing aids. Section C states whether the patient can make health care decisions or needs a surrogate. Section D lists emergency contacts with phone numbers. All but Section C are starred and required for Medicaid.
List the primary diagnosis and all other diagnoses. If the person is hospitalized, add the primary diagnosis at discharge, reason for transfer and surgical procedures during the stay; use a separate page if space runs out. Attach a medication reconciliation form or medication list that shows medication history and which medications continue or stop, since medications must be discussed in the hand-off.
Section F covers PPD status and screening date, infections or resistant organisms (MRSA, VRE, ESBL, MDRO, C. diff) with sites, and isolation precautions. Section G, which is required, records CHF and last echocardiogram with LVEF, proton pump inhibitor and antibiotic use, risks such as falls, elopement, pressure ulcers, harm to self or others, swallowing difficulty and seizures, restraints, pending lab results and allergies, including latex and dye.
Section H asks whether an advance directive, living will, DNR, do-not-intubate, do-not-hospitalize, no artificial feeding or hospice election exists, and to attach the documents. Sections I to L serve the transfer use: transferring facility with admit and discharge dates and times and the discharge nurse, receiving facility, primary care physician and hospitalist contacts, and time-sensitive medications, including whether a controlled substance script was sent.
Record the pain level from 0 to 10 and when pain medication was last given. Section N, which is required, lists the reports to attach when available: physician orders, discharge summary, medication reconciliation, discharge medication list, PASRR Level I and Level II forms, social and behavioral history, treatment orders (noting wound care), labs, imaging, EKG and history and physical. The medication list itself must always be attached.
Section O records height, weight, temperature, blood pressure, heart rate, respiratory rate and SpO2 with the date and time taken. Section P, required, covers bladder and bowel status, catheter details with insertion date and indication, and influenza and pneumococcal immunization. Section Q, also required, lists dietary instructions, tube feeding type and insertion date, supplements, TPN, and whether the patient eats independently, with assistance or with difficulty swallowing.
Section R lists therapies (PT, OT, speech, dialysis) with frequency. Section S, required, covers ambulation, transfer assistance, devices and weight-bearing. Section T marks pressure ulcer locations on the diagram with stages. Section U, required, picks one cognitive status, from alert and oriented to not alert. Section V notes IV or PICC access, cardiac devices, wound vac, oxygen and respiratory support. Section W lists personal items sent with the patient.
An optional free-text box with a signature and printed name; a nurse or social worker who enters comments may sign it. It is also where a provider other than the original signer records later changes: they initial each change or addition and add their name, signature, Florida license number and contact phone.
The physician, ARNP or PA checks whether the person requires nursing facility services and whether they received care for the condition during hospitalization, or instead certifies the need for Medicaid waiver services in lieu of nursing facility placement. Mark rehab potential (good, fair, poor) and the effective date of the medical condition, then sign with printed name and title, license number, date and phone.
Enter the printed name and contact phone of the person who filled in the form. This is required only when the medical professional who signed did not complete it, and only people working with that signing professional may complete the form. If the signing physician, ARNP or PA filled it in personally, Section Z can stay blank.
Download the current version from the source each time; forms change without notice.
Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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A Florida-licensed doctor of medicine or osteopathy, an advanced registered nurse practitioner within scope of practice, or a physician assistant if delegated by the supervising physician. A physician, ARNP or PA licensed by the U.S. military, the VA or another state can sign if a copy of their valid, current license accompanies the form.
For Medicaid eligibility purposes, one year from the date of the health care professional's signature, unless the individual's condition has changed significantly since it was completed. CARES reserves the right to request a new 3008 after a significant change in condition or if the form appears to have been altered.
Items marked with an asterisk are required for Medicaid, including patient name, last 4 SSN digits and date of birth on both pages, patient information, sight and hearing, emergency contact, medical condition, risk alerts, attached reports and medications, health status, nutrition, physical function, cognitive status and the physician certification. CARES cannot accept the form if any are missing.
Yes. The instructions state the medication list is not optional and must be attached. Section E asks for a medication reconciliation form or medication list showing which medications continue or stop, and Section N says to attach a list if there is not enough room to record all medications on the form.