Get Odm Form 9401

Completing the Odm Form 9401 online is a straightforward process. This guide provides you with clear, step-by-step instructions for filling out the form accurately, ensuring that you can complete it with confidence.

Follow the steps to fill out the Odm Form 9401 online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This allows you to access the electronic version of Odm Form 9401.
2. Fill in the date of service. Use the format mm/dd/yyyy to ensure clarity on the date the services were provided.
3. Enter the practice name and complete the practice address fields, including city, state, and zip code to ensure the correct identification of the service provider.
4. Input the patient's 12-digit Medicaid ID or managed care ID, followed by their first and last name to maintain proper identification. If using a managed care ID, include the patient's social security number as well.
5. Provide the patient's address, date of birth, and gestational weeks and days to gather comprehensive information regarding the patient’s pregnancy.
6. Indicate the patient's preferred method of communication by listing their primary language and including any contact numbers or email addresses.
7. Select any necessary assistance options related to the patient's care needs, checking the appropriate boxes.
8. Complete the progesterone candidate section if applicable, detailing any required information about medication needs.
9. In the prescribing section, fill in the prescriber's information, including their name, credentials, and contact details to ensure the proper handling of the prescriptions.
10. Review the completed form for accuracy and completeness before taking actions to save changes, download, print, or share the form as needed.

Take the next step and complete your documents online for a smoother process.