Get Pr Ma-34 2009-2025

The PR MA-34 is an essential form used in the Puerto Rico Medicaid program for certifying fixed expenses related to medications. This guide aims to provide clear, step-by-step instructions to help users accurately complete this form online.

Follow the steps to fill out the PR MA-34 online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Enter the family unit number in the designated field. This number is crucial for identifying your application within the Medicaid program.
3. Input the name of the head of the family unit in the appropriate section. Ensure accuracy to avoid any processing delays.
4. Provide your authorization in the 'Authorization of Applicant' section. Write your signature in the designated area and include the date when you sign the document.
5. In the 'Certification of the Physician' section, the physician must confirm the patient's condition. They should accurately fill in the patient's name and diagnosis while providing their licensed signature.
6. Next, the physician will list the prescribed medications in the specified columns and provide their associated monthly costs. Each medication should be clearly detailed for appropriate evaluation.
7. The pharmacist must certify the medications and provide their signature along with their license number. Ensure that all details are complete before moving on.
8. Once all fields are filled out, review the form for any errors, save your changes, and proceed to download, print, or share the completed form.

Complete the PR MA-34 form online today for a smoother Medicaid application process.