Get Abortion Statement Form - Advicare Health

This guide provides clear and supportive instructions on how to complete the Abortion Statement Form - Advicare Health online. Whether you are a first-time user or familiar with such forms, this comprehensive guide will help you navigate each section effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the Abortion Statement Form. This will allow you to open the document in a suitable editor.
2. In the first section, enter the patient’s name. This can be done either by typing directly or by handwriting if necessary.
3. Next, fill in the patient’s Medicaid ID number. Ensure this information is accurate, as it is vital for processing.
4. Provide the complete address of the patient. This step is crucial, and you can choose to type or write this information.
5. Proceed to the physician certification statement section. Here, enter the name of the physician who performed the abortion, which can also be typed or handwritten.
6. Indicate the necessity for the abortion by checking the appropriate box. Choose based on the relevant circumstances outlined in the options provided.
7. If applicable, write the diagnosis or name of the medical condition that justifies the abortion in the designated space.
8. The physician must sign their name in the signature section and date the form in their own handwriting.
9. If the abortion is due to rape or incest, the patient must complete the certification statement section, stating the reason.
10. The patient should then sign their name in the designated signature area and date the form in their own handwriting.
11. Lastly, ensure that both the completed Abortion Statement and any required medical records are prepared for submission. Save changes to the document, and consider options to download, print, or share the completed form as needed.

Complete your Abortion Statement Form - Advicare Health online today to ensure accurate and timely processing of your documentation.