Get La Bhsf Form 96-a 2006

The LA BHSF Form 96-A is an important document related to the Medicaid program, specifically acknowledging the receipt of hysterectomy information. This guide will provide clear, step-by-step instructions to help you fill out the form online efficiently.

Follow the steps to complete the LA BHSF Form 96-A online

1. Press the ‘Get Form’ button to obtain the document and launch it in the online editor.
2. Enter the name of the recipient in the designated field. Ensure the spelling is accurate as this will be used for identification purposes.
3. Fill in the MEDS Person Number for the recipient. This is essential for processing within the Medicaid system.
4. Provide the physician's name in the corresponding section. This helps clarify who is responsible for the medical procedure.
5. Input the provider number, which identifies the healthcare provider performing the hysterectomy.
6. Read the important information regarding the conditions under which Medicaid payment for the hysterectomy can be authorized. Ensure you understand the implications of signing the form.
7. Acknowledge the receipt of information by signing the designated area for the recipient. This signature confirms that you have been informed both orally and in writing.
8. If there is a representative acting on behalf of the recipient, they must sign the provided space as well, indicating their acknowledgment.
9. Complete the date fields next to each signature, ensuring that both the recipient and representative's dates are accurately recorded.
10. Once all sections are filled out correctly, you can save the changes, download the completed form, print it, or share it as needed.

Complete your documents online today for a seamless experience.