Get Map-235 2000-2025
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How to fill out the MAP-235 online
The MAP-235 form, also known as the certification form for induced abortion or induced miscarriage, is an essential document that must be completed by a certified medical professional. This guide provides a comprehensive overview of how to accurately fill out this form online, ensuring all necessary information is correctly included.
Follow the steps to complete the MAP-235 form effectively.
- Click the ‘Get Form’ button to access the MAP-235 form and open it in your preferred online document editor.
- In the first field, enter the physician’s name who is certifying the procedure. Ensure correct spelling and include any relevant titles.
- Next, provide the name of the patient in the designated space. It's important to use the full legal name as it appears on the patient's identification.
- Fill in the patient’s MAID number, which is a specific identification number that must be associated with the patient’s medical record.
- Complete the patient's address, being sure to include the street address, city, state, and zip code for accurate records.
- Check the appropriate box to indicate the type of medical condition the patient is suffering from, whether it is a physical disorder, physical injury, or physical illness.
- In the next section, indicate the date and the specific procedure(s) that were performed. This information is crucial for the medical necessity of the intervention.
- The physician should then provide their signature, confirming the authenticity of the information provided. This must be done digitally if filling out the form online.
- Finally, the physician should print their name and provide their license number, along with the date of certification.
- After completing all sections, make sure to save changes. You will have the option to download, print, or share the completed MAP-235 form online.
Complete your documents online with confidence and accuracy.
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