Get Qualifying Diagnosis Certification - Dhss Alaska

Filling out the Qualifying Diagnosis Certification is an important step in determining eligibility for services for individuals with intellectual and developmental disabilities in Alaska. This guide will provide you with clear, step-by-step instructions on how to complete the form effectively online.

Follow the steps to fill out the certification form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the applicant or participant's name in the designated field, followed by their date of birth and Medicaid number. This information is crucial for the processing of the form.
3. In the diagnosis section, initial each applicable condition listed (for example, Intellectual Disability or Cerebral Palsy) and provide the corresponding ICD-9 code. If the ICD-9 code is missing, note that the form will be returned for correction.
4. For each diagnosis, ensure that the medical provider's initials are included to validate the diagnoses reported. This is an essential requirement for the information to be accepted.
5. Include any additional diagnoses in the specified section along with any necessary comments or explanations that could assist in the assessment process.
6. Provide the age at which the diagnosed condition began. This information can be a significant factor in determining eligibility for services.
7. Once all fields are accurately filled out, complete the form by adding the signature of the medical provider, along with the date, printed name, telephone number, and license number.
8. Finally, review all provided information for accuracy. You may then choose to save changes, download, print, or share the completed form as needed.

Complete your Qualifying Diagnosis Certification online today to ensure timely processing of services.