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Long-Term Care Forms ; Form 431, MDS Section Q Nursing Home Discharge Planning Checklist ; Form 12-001, Admission and Evaluation Assessment Tool for PACE Program. Items 14 - 33 — Providers may use these instructions to complete this form.Find the forms you need to serve members and transact business with the IHCP. We believe you will find the format and search capabilities of this Manual to be user-friendly and having all policies in a single document very convenient. About Washington Apple Health (Medicaid). About Washington Apple Health (Medicaid). Here you can find all your provider forms in one place. If you have questions or suggestions, please contact us. Behavioral Health (Medicaid Only - BCCHP and MMAI) ; Community Based BH Request Form, Medicaid only ; Electroconvulsive Therapy (ECT) Request Form, Medicaid only. In This Report: Introduction; Background; Issues to Consider as Children Transition to Other Sources of Coverage.