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How to fill out the Fhp Form online
Filling out the Fhp Form online is a crucial step in requesting therapy services such as speech, physical, and occupational therapy. This guide will provide you with a clear, step-by-step approach to ensure all necessary information is accurately completed.
Follow the steps to complete the Fhp Form accurately.
- Press the ‘Get Form’ button to acquire the Fhp Form and open it in your preferred online editor.
- Begin by entering the member's full name and Fidelis Member ID number in the designated fields.
- Input the date of birth for the member in the appropriate section.
- Indicate the type of therapy services being requested by selecting the relevant checkboxes for speech therapy, physical therapy, or occupational therapy.
- Provide the ICD-9 diagnosis code(s) and CPT/procedure code(s) that correspond to the requested therapy.
- If applicable, check the boxes for Medicare, Workers' Comp, or No-Fault, and enter the corresponding dates for surgery or injury.
- Fill in the name and contact details of the referring provider, including their phone number and Tax ID or NPI number.
- Specify the dates for the initial visit and the last visit, along with the number of visits and frequency of therapy requested.
- Answer questions regarding previous therapy treatment, progress since the last request, and confirm if a home program is in place.
- Enter the name of the therapist and the facility providing the therapy services, including their contact information.
- Ensure all fields are filled out completely before submitting. Incomplete forms may delay the approval process.
- After filling out the form, you may save changes, download a copy, print it, or share it as required.
Complete your Fhp Form online today to streamline your therapy request process.
Related links form
The time it takes to receive a Florida crash report varies depending on the delivery method. Typically, if you apply online with the Fhp Form, you may get your report within a few days. However, requests made in person may provide you with faster results, often the same day. Keep in mind that during busy periods, it might take a little longer, so it's best to plan ahead.
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