Dutton & Casey Medicaid Planning Form

To fill out a form on, you can save your progress by registering and logging in to the system… To do that, please:

  1. Please visit: (alernatively, you can click on the register link on the form page)
  2. Follow the instructions to create a username and a password will be emailed to you.
  3. Once you are registered and receive the email with your password, enter your username/password into the fields on the left side of the form (the URL to the correct form(s) should have been emailed to you).
  4. Fill out the form making sure to click on SAVE PROGRESS at the bottom of the form if you cannot complete the form at that time.
  5. Once saved, you can return to the form by clicking on the form link sent to you via email at any time and clicking on your saved form to resume.
  6. Use the links at the top of the form to navigate to the last section you remember entering information or to review previously entered data.
  7. Always remember to click on SAVE PROGRESS to ensure your data is stored in case you must abandon the form until a later time.
Fields marked with a * are required

Please answer the following questions in relation to the time frame of the last 60 months (five years).

If yes, please know that, when completing a Medicaid application, documentation will need to be provided for any transaction $500.00 (five hundred) or more.

Information on Personal Representative Submitting Form

We look forward to learning more about your legal concerns and discussing how we can best assist you. If you have any questions as you prepare for your meeting, please do not hesitate to contact our office at 312-899-0950, or 847-261-4708 or