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  • C015 1146 Sterilization Consent Form V.4.doc - Med-quest

Get C015 1146 Sterilization Consent Form V.4.doc - Med-quest

PROVIDER MANUAL: APPENDIX 3 CLAIMS FORMS Sterilization Required Consent Form DHS 1146 Form Pages C1 to C32 Pages C15.

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How to use or fill out the C015 1146 Sterilization Consent Form V.4.doc - Med-quest online

This guide provides clear and detailed instructions on how to complete the C015 1146 Sterilization Consent Form V.4.doc - Med-quest online. Follow these steps to ensure that all required information is accurately filled out for successful submission.

Follow the steps to complete the form accurately and efficiently.

  1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
  2. Carefully read each section of the form to understand the requirements and consent information before filling it out.
  3. In the first field, provide the name of the person providing consent, ensuring accurate spelling and capitalization.
  4. Next, enter any required identification numbers, such as a patient ID or Social Security number, in the designated fields.
  5. Complete the section regarding the details of the sterilization procedure by selecting the appropriate options or filling in the required information.
  6. Review the consent statement carefully. You may need to initial or sign next to this statement to indicate that you understand and agree to the procedure.
  7. If applicable, provide information about alternatives discussed and any additional comments in the designated area.
  8. Finally, save your changes, and download, print, or share the completed form as necessary for submission.

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In 1974 states like Georgia, North Carolina, and Virginia required spousal consent for procedures, but by the end of the 1970s, the requirement had been challenged by a handful of court cases, and federal courts ruled state spousal consent laws unconstitutional – though the Supreme Court has never issued a judgment on ...

No physician shall perform a nontherapeutic sterilization on any person before twenty- four (24) hours following the giving of written informed consent by the person requesting such sterilization. History: Created 1974 Ky. Acts ch. 352, sec.

If a procedure is medically necessary, the consent of the patient's spouse in not required. The consent of the spouse is not required even if it incidentally will result in the sterilization of the patient.

A properly completed Sterilization Consent Form (HHS-687) is required for all sterilization-related claims. This includes hospital claims and professional services (surgeon and anesthesia). All other requirements and instructions for the Sterilization Consent Form must be followed to ensure the consent form is valid.

30 days (but not more than 180 days) must pass after the sterilization consent form has been signed. The 30 days starts the day after the consent is signed. Private Pay patients may request in writing that procedure be performed in less than 30 days.

STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232