Patient forms
Medical Service Needs Certification (MDHHS-6200)
The MDHHS-6200 Medical Service Needs Certification documents the medical necessity for in-home care. It must be completed, signed, and dated by a Medicaid-enrolled provider holding a qualifying license.
Provider-completed form
Have your doctor send this form to us directly
MDHHS-6200 must be completed and signed by a Medicaid-enrolled provider — not by you or your family. Here's the simplest way to get it to us:
Email the completed forminfo@zentrahomecare.comTap to open your email app, or copy the address to share with your doctor.
Or fax the completed form(313) 846-4001Most doctor's offices can fax directly — quickest option if they have it on file.
- Call your doctor's office.Or the primary-care provider for the person receiving care.
- Ask them to complete the MDHHS-6200.You can download the blank form below and forward it to them by email or text.
- Have them send the completed form. Email to info@zentrahomecare.com as a PDF or scanned attachment, or fax to (313) 846-4001.
Once we receive the completed form from your provider, our enrollment team will follow up within one business day.