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  • Example Of Pm-330 Sterilization Consent Form - Medi-cal - Files Medi-cal Ca

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Example of PM-330 Sterilization Consent Form Penny L. Sillen, Bilateral Tubal Ligation Fields 2, 6, 13, & 20 Bilateral Tubal Ligation Bilateral Tubal Ligation Fields 4, 7, 12, & 18 Penny L.

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How to fill out the Example Of PM-330 Sterilization Consent Form - Medi-Cal - Files Medi-Cal Ca online

Filling out the Example Of PM-330 Sterilization Consent Form is a crucial step for individuals seeking sterilization under the Medi-Cal program. This guide provides step-by-step instructions to ensure you accurately complete the form online.

Follow the steps to successfully fill out the sterilization consent form.

  1. Click ‘Get Form’ button to obtain the sterilization consent form and open it in your preferred online document editor.
  2. Enter the name of the individual requesting the sterilization in the designated field. Ensure the name is spelled correctly as it will be used for official records.
  3. Complete sections regarding the type of sterilization being requested. For example, if you are indicating a bilateral tubal ligation, ensure you mark that option clearly.
  4. Review any additional fields that require information about the consent and understanding of the procedure. This includes health status and previous medical history, if applicable.
  5. In the fields that request signatures, ensure the physician's name is filled in accurately along with the date of completion of the form. Note that this date should be on or after the date of sterilization.
  6. If any paragraphs or sections do not apply to your situation, clearly cross off those sections as instructed on the form.
  7. Once all fields are filled in correctly, review the form for accuracy. Make any necessary edits or adjustments.
  8. Finally, save your changes, and you can download, print, or share the completed consent form as required.

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A sterilization will be covered by Medi-Cal only if the following conditions are met: 1. The individual is at least 21 years old at the time written consent for sterilization is obtained. Note: Under Medi-Cal regulations, a patient must be 21 years old to give consent to a sterilization.

The CPT-code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)) and ICD-10 code Z30. 2 (Encounter for sterilization are the appropriate codes for the bilateral salpingectomy) are the appropriate preventive codes for a bilateral salpingectomy.

CPT® 58670, Under Laparoscopic Procedures on the Oviduct/Ovary. The Current Procedural Terminology (CPT®) code 58670 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Procedures on the Oviduct/Ovary.

Procedure Code 58700 - Open procedures Fallopian Tubes, with/without ovaries salpingectomy, complete or partial, unilateral or bilateral (separate procedure). Bilateral tubal ligation (BTL) is a benefit under Texas Medicaid for sterilization under the appropriate circumstances.

The Current Procedural Terminology (CPT®) code 58611 as maintained by American Medical Association, is a medical procedural code under the range - Incision Procedures on the Oviduct/Ovary.

Sterilization is any medical or surgical procedure intended to render the client permanently incapable of reproducing. This includes vasectomies (CPT® code 55250), tubal ligations (CPT® codes 58600, 58605, 58611, 58615, 58670, and 58671), and hysteroscopic sterilizations (CPT® code 58565).

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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