Get Sc Dhec 1548 2017-2026

The SC DHEC 1548 form is essential for recertifying participation in the Insurance Assistance Program. This guide provides clear, step-by-step instructions on how to effectively fill out the form online, ensuring you're well-prepared to provide the necessary information.

Follow the steps to complete the SC DHEC 1548 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the Enrollee Information section, enter the DAP ID if available, last name, first name, full middle name, month and year of birth, the last four digits of the Social Security number, and gender. Provide your current residence address, city, county, mailing address if different, and contact numbers for home and other communication. Be sure to include ethnicity and race by checking the appropriate boxes.
3. In the Eligibility Information section, provide your estimated yearly gross income, place of employment, and details of any other household members. Each member's relationship to you, gender, date of birth, and their income sources should be documented. Proof of income should be attached if needed.
4. The Benefits Information section must be filled out by your physician or case manager. Indicate if you have Medicaid or Medicare Part D coverage, and if there are pending applications for these services.
5. The Clinical Information section requires entries from your physician. This includes your current disease stage, the date of HIV diagnosis, and other specifics related to your health status, including recent CD4 counts and viral load results.
6. In the Certification/Consent section, carefully read each statement before signing to affirm the accuracy of the information provided. Both the enrollee and the referring physician or case manager must sign and date the document.
7. Finally, review the entire form to ensure all sections are completed. Save any changes made, and choose to download, print, or share the form as necessary.

Start filling out the SC DHEC 1548 online today to ensure timely recertification!