Get Ga Dma-6a 2018-2025

The GA DMA-6A form is an essential document for individuals applying for Medicaid services. This guide provides a clear and step-by-step approach to completing the form online, ensuring accuracy and efficiency in your application process.

Follow the steps to successfully complete the GA DMA-6A online form:

1. Click ‘Get Form’ button to obtain the GA DMA-6A and open it in your editor.
2. In Section A, enter the applicant’s identifying information. Provide the applicant’s name, address, Medicaid number, social security number, sex, age, birthdate, and DFCS county information.
3. List the mailing address of the applicant clearly.
4. Fill in the name and contact information of the primary care physician, and the applicant's telephone number.
5. Indicate whether, in the caretaker's opinion, the child would require institutionalization without community services by selecting 'Yes' or 'No'.
6. Record whether the child attends school by selecting 'Yes' or 'No'.
7. Enter the date of the Medicaid application.
8. Provide the names of the caregivers responsible for the applicant.
9. Sign and date the authorization for the disclosure of protected health information.
10. In Section B, enter the physician's report and recommendations. Include the history, diagnosis, medications, and any diagnostic and treatment procedures.
11. Outline the treatment plan. Attach additional sheets if necessary to provide complete information.
12. Indicate the anticipated dates of hospitalization and the level of care recommended by checking the appropriate box.
13. Choose the type of recommendation: initial, change level of care, or continued placement.
14. Specify the source from which the patient has been transferred.
15. Indicate the length of time care is needed (permanent or temporary).
16. Answer the question regarding whether the patient's condition can be managed through community care or home health services.
17. Provide the physician’s name, address, licensure number, and contact information.
18. Ensure all information is accurate and complete before finalizing.
19. Once completed, save your changes, download, print, or share the form as needed.

Begin completing your GA DMA-6A online today for a smooth application process.