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  • Ch-5.doc - Okhca

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6-Month Child Health Supervision (EPSDT) Visit HT ( % ) WT ( % ) HC ( % ) Patient Sticker NAME DOB DOV AGE SEX MED REC# Temp Pulse Meds: Pulse Ox-Optional Resp: Allergies: NKDA Reaction: SENSORY SCREENING:.

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How to fill out the CH-5.doc - Okhca online

This guide provides a comprehensive overview of how to accurately complete the CH-5.doc - Okhca online. By following the step-by-step instructions outlined below, users can ensure that all necessary information is submitted correctly and efficiently.

Follow the steps to complete the CH-5.doc - Okhca online.

  1. Click the ‘Get Form’ button to access the CH-5.doc - Okhca and open it for editing.
  2. Fill out the patient sticker section, including the name, date of birth, date of visit, age, sex, and medical record number.
  3. Enter the height, weight, and head circumference, along with their respective percentiles.
  4. Record the vital signs such as temperature, pulse, and optional pulse oximetry reading. Include any medications currently taken by the patient.
  5. List any known allergies, along with any reactions to them, if applicable.
  6. In the history section, note any parental concerns and provide maternal and birth history if the birth history form has been reviewed.
  7. For the sensory screening, indicate if there are any parental concerns about vision or hearing, and check the appropriate box for follow-up observations.
  8. Complete the physical examination section by checking boxes for normal, abnormal, or not examined for each item listed under general observations.
  9. In the anticipatory guidance section, select topics that apply to the child and check them as appropriate.
  10. Document any procedures performed, including immunizations, and record whether they were given, not given, or up to date.
  11. Conclude with the assessment section, summarizing the child's health status, and outline the plan or recommendations.
  12. Finally, ensure that the provider signature and date are clearly filled out at the bottom of the form.
  13. After completing all sections, save your changes, download a copy for your records, print the form, or share it as needed.

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Stat. 5008(B). c) The mailing address for OHCA is: Oklahoma Health Care Authority, Attention: Provider Contracting, P.O. Box 54015, Oklahoma City, OK 73154.

WHAT IS SOONERCARE? SoonerCare is the brand name given to Oklahoma's Medicaid program. Medicaid is a program that covers medical expenses for certain groups of people who have limited income and resources. The Oklahoma Health Care Authority is the state agency that administers the program.

SoonerCare (Oklahoma Medicaid) covers many health care services. However, there are limitations that apply to ensure that only medically necessary services are provided.

Providers can submit claims electronically utilizing clearinghouses in conjunction with the electronic claims payer ID 22521. Contact the claims administrator for more information.

For assistance with the Online SoonerCare Application or other questions or concerns about SoonerCare, please call the SoonerCare Helpline at 800-987-7767.

Timely filing is 183 calendar days from the date of service.

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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
Help Portal
Legal Resources
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