Get Ar Division Of Medical Services Dms-640 2016-2025

Filling out the AR Division Of Medical Services DMS-640 online is essential for obtaining necessary therapy services for Medicaid-eligible beneficiaries under the age of 21. This comprehensive guide provides step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the DMS-640 online.

1. Click the ‘Get Form’ button to access the DMS-640 online and open it for editing.
2. Indicate the type of therapy needed by checking all applicable boxes: Occupational Therapy (OT), Physical Therapy (PT), or Speech Therapy (ST). Note that 'Evaluate/Treat' is not a valid prescription.
3. Enter the patient's full name in the 'Patient Name' field.
4. Fill in the patient's Medicaid ID number in the designated field.
5. Provide the date when the child was last seen in the office to establish context for the therapy request.
6. Enter the diagnosis that relates to the necessity of the prescribed therapy in the appropriate field.
7. If this form is being used as a prescription, complete the 'Prescription' block by including the number of minutes of therapy per week and the duration in months.
8. If it is determined that therapy is not medically necessary, check the corresponding box.
9. Add any other relevant information pertaining to the child's medical condition in the 'Other Information' section.
10. Print the name of the Primary Care Physician (PCP) along with their provider ID number or taxonomy code in the specified fields.
11. If applicable, print the attending physician's name and their provider ID number or taxonomy code as well.
12. Ensure that the prescribing physician signs and dates the form with their original signature.
13. Review all entries for accuracy and completeness before finalizing the form.
14. Once completed, save your changes, and download, print, or share the DMS-640 form as necessary.

Complete your documents online today to ensure timely access to necessary therapy services.