Get La Ocddwss-pf-11-001

The LA OCDDWSS-PF-11-001 form is essential for delegating responsibilities for medication administration and medical treatments within the Medicaid system. This guide provides clear and comprehensive instructions on how to fill out the form online accurately and efficiently.

Follow the steps to successfully fill out the LA OCDDWSS-PF-11-001 online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the participant's name and Medicaid number in the designated fields at the top of the form.
3. Next, enter the date the form is being completed in the provided section.
4. Fill in the provider agency name and the contact phone number for the agency.
5. Under the employee section, input the name of the employee who will be administering the medication or treatment. Note that only one name should be provided per page of the form.
6. Detail the medication or treatment being delegated, including specific instructions regarding the dosage and administration site.
7. The delegating physician must sign and date the form to indicate their authority and approval of the delegation.
8. Fill in the physician’s name, address, city, state, zip code, and phone number in the respective fields.
9. The employee must acknowledge their training by signing and dating the form, confirming their agreement to administer the medication or treatment as instructed.
10. Review all entered information for accuracy. Once satisfied, you can save changes, download the completed form, print it for records, or share it as necessary.

Complete the LA OCDDWSS-PF-11-001 form online today to ensure effective medication administration and medical treatment delegation.