New Jersey Department of Human Services

Division of Aging Services

PO Box 807

Trenton, New Jersey 08625-0807

1-877-222-3737

www.aging.nj.gov

Global Options for Long-Term Care

(GO) Medicaid Waiver Program

Participant Handbook

Cover Sheet

The Global Options Participant Handbook and Enrollment Agreement provide an overview of the program and the rights and responsibilities of participating. It is important that you understand the eligibility requirements, services, providers, and also the limitations of this program so you can make informed decisions about your care.

As evidence that you have received the GO Participant Handbook, and that the content of it has been reviewed with you by your Care Manager, please sign below.

This Cover Sheet will be retained in your case file.

The Handbook is yours to keep for future reference.

Issued to:

Participant Name

On (Date)

Legal Representative Name

On (Date)

Signature of Participant	Signature of Legal Representative
My signature indicates that I have been informed of and understand my rights and responsibilities under the GO Medicaid Waiver program. I have received this information verbally and in writing.

Global Options Participant Handbook	Page 0

GO 499 (07/10)

GO-2 [GO 499]

JUL 12

GO-2, partipant handbook cover page

GO-2, (GO 499), GO, global options, participant handbook, cover page, long term care, medicaid waiver

2010-12-15

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