Get Amerigroup Iapec-0134-15 2015-2025

Completing the Amerigroup IAPEC-0134-15 form online is a crucial step for ensuring accurate patient discharge documentation. This guide will provide you with a clear, step-by-step process to successfully fill out the form.

Follow the steps to complete your Amerigroup IAPEC-0134-15 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter today’s date in the designated field at the top of the form. This indicates when the discharge documentation is being completed.
3. Provide the member's name in the specified section, ensuring the spelling matches official records.
4. Fill in the member ID or reference number accurately to link the form to the correct patient record.
5. Input the member's date of birth, address, and phone number to ensure easy identification and contact.
6. State the name of the facility from which the member is being discharged and include its NPI or Amerigroup provider number.
7. Indicate the date of discharge and provide the discharge address and contact number for follow-up.
8. Select 'Yes' or 'No' regarding whether the discharge was against medical advice, then indicate if discharge information was sent to the PCP or psychiatrist.
9. Confirm if the discharge plan was discussed with the member and note any informed consent required for minors.
10. Check all applicable options for the discharge plan, including any additional services provided.
11. Document the ICD-10 discharge diagnoses relevant to the patient's condition.
12. List all discharge medications along with their doses and ascertain if they are on the formulary or require precertification.
13. State whether precertification has been obtained if needed for any medications.
14. Conduct a risk assessment, clarifying if the member was stable at discharge regarding any risk of suicide, homicide, or psychosis.
15. Provide details for the discharge appointment, including the provider's name, contract number, tax ID number, and whether they are an in-network provider.
16. Specify the date and time of the appointment, and note any barriers to attendance that have been identified.
17. Complete the submission section by entering your name and contact phone number before submitting the form.

Complete your documentation online to ensure timely and accurate patient care.