Get Itop Form - Alaska Department Of Health And Social Services - Dhss Alaska

This guide provides a step-by-step approach to completing the ITOP Form for the Alaska Department of Health and Social Services. Users will find clear instructions to navigate the form efficiently and accurately.

Follow the steps to successfully complete the ITOP Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's age in the first section of the form. This requires you to provide the patient’s age as of the date of pregnancy termination.
3. Input the date of pregnancy termination in the designated field (MM/DD/YY format). This is crucial for record-keeping.
4. Specify the city where the termination of pregnancy occurred. This provides necessary geographical context.
5. Indicate the patient's race and ethnicity from the provided options. Ensure accurate representation by selecting the appropriate categories.
6. Provide the city and state where the patient resides. This information is important for administrative purposes.
7. Indicate marital status by checking 'Yes' or 'No' for whether the patient is married.
8. Complete the education section indicating the highest grade completed by the patient, selecting from the specified options.
9. In the previous pregnancies section, detail the number of live births, previous spontaneous abortions, and induced terminations. Do not leave these fields blank.
10. Enter the physician's estimate of gestation. This should correspond with the medical evaluation.
11. Record the date when the last normal menses began in MM/DD/YY format.
12. Select the method of payment from the options provided.
13. Detail the primary procedure used to terminate the pregnancy. Different options should be selected based on the procedure performed.
14. Indicate if this termination was elected due to the detection of a congenital anomaly by selecting 'Yes' or 'No'.
15. Provide specific information regarding any congenital anomaly if applicable.
16. Before finalizing the form, ensure that all sections are completed. Users can save changes, download, print, or share the form once finished.

Complete the ITOP Form online accurately and efficiently.