Get Certification Request Form.xls - Dphss Guam

Filling out the CERTIFICATION REQUEST FORM.xls - Dphss Guam is an essential process for obtaining necessary certifications. This guide provides step-by-step instructions to ensure you complete the form correctly and efficiently.

Follow the steps to successfully submit your certification request.

1. Click 'Get Form' button to access the certification request form and open it in your preferred online document editor.
2. Enter the date in the specified field, following the format MM/DD/YYYY for accuracy.
3. Fill in your name, including your first name, middle initial, and last name in the designated areas.
4. Provide your contact number, ensuring that you include the area code.
5. Input your Social Security number in the format XXX-XX-XXXX to maintain confidentiality and correctness.
6. Identify your case worker by entering their name in the corresponding field.
7. Specify your case number, which is essential for tracking your request.
8. Select the type of certification you are requesting from the provided options, such as child support, GTA, GHURA, WIC, Medicaid not received, MIP not received, or other (please specify).
9. Explain the reason for your request in the dedicated area, providing necessary details.
10. If applicable, indicate the name of the GMHA or medical provider related to your request.
11. Enter the date of billing related to the certification request.
12. Provide the patient's name if the request pertains to a specific individual.
13. Review all entered information for accuracy and completeness.
14. Save your changes, and you can choose to download, print, or share the completed certification request form.

Complete your certification requests online today for prompt processing.