Get Maryland Dda Ohcds Form

Filling out the Maryland Dda Ohcds Form online is an essential step for organizations seeking designation as an organized health care delivery system. This guide will provide you with clear instructions on how to complete each section of the form effectively.

Follow the steps to complete the Maryland Dda Ohcds Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of your organization in the designated field labeled ‘Provider Name’. Ensure that the name accurately reflects the organization you represent.
3. Fill in the ‘Provider Address’ section with the complete address where your organization operates. This should include street address, city, state, and zip code.
4. Input the ‘Provider Phone’ number, making sure it is active and can be used for communication regarding the application.
5. In the section that requires submission by an authorized individual, write the name of the person who is filling out the form. This could be the CEO or Board President, according to the title specified.
6. Indicate the title of the person filling out the form by selecting from the options provided. This is crucial for the validation of the application.
7. Confirm that the organization provides at least one Medicaid service by adding the MA Provider Number in the appropriate field. Initial this section to confirm.
8. Complete the remaining affirmations regarding compliance with standards and reporting requirements, ensuring to initial each statement as an acknowledgment of understanding.
9. Once all sections are filled out, review the information for accuracy before finalizing the form.
10. Finally, save your changes, and you will have the option to download, print, or share the completed form as needed.

Take action today and start filling out the Maryland Dda Ohcds Form online to ensure your organization is designated as an OHCDS.