Get La Bhsf Form 142 2012-2025

The LA BHSF Form 142 is crucial for individuals seeking medical certification through Louisiana's Medicaid program. This guide provides clear and supportive steps to help users fill out the form accurately and efficiently online.

Follow the steps to complete the LA BHSF Form 142 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the Social Security Number (SSN) and the date of birth in the designated fields; ensure the accuracy of this information as it is vital for identification purposes.
3. Fill in the Medicaid Number to associate the form with the correct Medicaid account.
4. Provide the recipient's full name and home address accurately to ensure proper processing.
5. Complete the details for the facility/provider/support coordinator, including their name and vendor number where applicable.
6. Indicate the facility address and parish to further specify the location of the services.
7. Select the appropriate eligibility status in Section I, checking whether the person has been approved or denied Medicaid services, and include the effective dates as necessary.
8. In Section II, mark the decision regarding Level II assessments to clarify admission statuses as required.
9. If applicable, complete Section III regarding waiver or PACE services, specifying any relevant information about the approval or denial of services.
10. Review all entered information for accuracy, then choose to save your changes, download the document, print it, or share it as required.

Start filling out your LA BHSF Form 142 online today for a smooth eligibility process.