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Get Southeastrans Public Transportation Attendance Verification Form ...
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How to fill out the Southeastrans Public Transportation Attendance Verification Form online
The Southeastrans Public Transportation Attendance Verification Form is essential for verifying that a Medicaid member attended their scheduled medical appointment. This guide will help you understand the form's components and provide clear instructions for completing it online.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the form and open it in the editor.
- In the first section, input the member's name. Fill in the last name followed by the first name.
- Next, move to the appointment information section. Enter the appointment date and time in the designated fields.
- In the treating physician section, provide the physician’s name. Ensure this is filled out accurately as it is required for verification.
- The physician must then sign their name in the designated area and provide the date the signature is given.
- If the member requires ongoing transportation, indicate how many days per week they need to attend the facility by selecting the appropriate option from one to seven.
- Finally, review all the information entered for accuracy. Once confirmed, users can save the changes, download the form, print it, or share it as needed.
Complete your documents online to ensure timely transportation verification.
The retooled program will be called the Arkansas Health and Opportunity for Me program, or ARHOME, starting Jan. 1 and ending Dec. 31, 2026, under the waiver approved by the U.S. Centers for Medicare and Medicaid Services.
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