Get Nd Dhs Sfn 1812 2020-2025

Filling out the ND DHS SFN 1812 form is essential for certifying the need for services in an intermediate care facility. This guide provides step-by-step instructions for completing the form efficiently online.

Follow the steps to successfully complete the ND DHS SFN 1812 form.

1. Click the ‘Get Form’ button to access the ND DHS SFN 1812 document and open it in the editing tool.
2. Complete the 'Developmental Disabilities Provider Information' section by entering the provider name, address, NPI, city, state, and ZIP code.
3. Fill in the 'Recipient Information' section with the recipient's name, their provider NPI, city, state, and ZIP code.
4. In the 'Certification Period' section, input the start and end dates of the certification period using the MM/DD/YYYY format.
5. Proceed to the 'Certifying Physician Information' section. Enter the certifying or attending physician's name, address, NPI, city, state, and ZIP code.
6. The certifying physician must sign the form electronically by typing their name in the signature field, confirming the signature's validity.
7. Record the date of the electronic signature accurately.
8. Once all sections are completed, save your changes. You may also download, print, or share the form as needed.

Complete your ND DHS SFN 1812 form online today for efficient processing.