Hawaii Level of Care Forms and Resources
Click the links below to access and print the most-current evaluation forms and instructions approved by the Med-QUEST Division:
DHS/MQD Form 1147 (Revised 6/2023)
DHS/MQD Form 1147 Instructions (Revised 6/2023)
DHS/MQD Form 1147a (Revised 6/2023)
DHS/MQD Form 1147a Instructions (Revised 6/2023)
DHS/MQD Form 1147e (Revised 6/2023)
DHS/MQD Form 1147e Instructions (Revised 6/2023)
Functional Status Assessment Instructions and Examples (Revised 1/1/2021)
Level of Care Criteria Matrix (Revised 3/8/2024)
HILOC-1147 Technical Support Contacts (Revised 1/21/2024)
At-Risk Criteria and Process
Click the links below to access and print the most current At Risk information from the Med-QUEST Division:
Criteria for At-Risk Population (effective 5/14)
Training Materials
Click the links below to access and print helpful information about Hawaii level of care criteria:
DHS/MQD Level of Care and At Risk Evaluation 1147 Form PowerPoint Presentation
MedQUEST Long Term Care Services Information
