Get Sc Dshs 1282 2016-2025

The SC DSHS 1282 form is an important document used for appointing an authorized representative for Medicaid applications, reviews, and appeals. This guide will provide detailed instructions on how to fill out this form online to ensure that you understand each section and can complete it accurately.

Follow the steps to complete the SC DSHS 1282 form online.

1. Press the ‘Get Form’ button to access the SC DSHS 1282 form and open it in your online editor.
2. Begin by entering the name of the Medicaid applicant or member in the designated field.
3. Input the Social Security Number of the Medicaid applicant or member.
4. In the section titled 'Appointing an Authorized Representative,' indicate if you would like to allow someone to represent you by checking the appropriate box.
5. If you wish to appoint an authorized representative, provide their full name, including first name, middle name, and last name.
6. Fill out the address of the authorized representative, including apartment or suite number, city, state, and ZIP code.
7. Enter the authorized representative's primary phone number and any additional phone number if applicable.
8. Include the authorized representative’s email address and organization name if applicable.
9. If applicable, identify the specific unit of the authorized representative's organization.
10. If you wish to give permission to release information to someone else who is not an authorized representative, fill out the section 'Permission to Release Information' with the name, phone number, address, and other details.
11. The Medicaid applicant or member must sign and date the form. If unable to sign, provide reason for incapacity.
12. If signing with an 'X,' include two witness signatures as required.
13. Once completed, save your changes, and choose to download or print the form for submission.

Complete your SC DSHS 1282 form online today to ensure your Medicaid application process is efficient.