Get Hi Amhd Contracts 2013-2025

Filling out the HI AMHD Contracts online is a straightforward process designed to facilitate necessary changes in service locations and contact details. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the HI AMHD Contracts form online.

1. Press the ‘Get Form’ button to access the HI AMHD Contracts form and open it in your preferred editor.
2. Enter the agency name at the top of the form.
3. Indicate the current date in the designated field.
4. Select the type of service(s) provided by your agency.
5. Fill in the contact name and telephone number for the service.
6. Choose the appropriate action to take: Add, Change, or Close.
7. Specify the effective date of the action.
8. Provide the reason for the action being taken.
9. If changing the physical location, fill in the old location address, including the 4-digit zip code extension.
10. Enter the new location address.
11. Indicate whether the new address is the agency's primary business location by selecting Yes or No.
12. If No, provide the address of the primary location.
13. Indicate if this is also a mailing address change for claims and payment by selecting Yes or No.
14. If you selected Yes for the mailing address change, attach a letter on your organization’s letterhead with an executive staff signature.
15. Fill in the old telephone/facsimile number.
16. Enter the new telephone/facsimile number.
17. Specify the last date consumers will be seen at the old location.
18. Indicate if the new physical location has been added to your agency’s Certificate of Liability Insurance (COLI) by selecting Yes or No.
19. If Yes, attach a copy of the COLI.
20. Print the name and title of the person signing the form.
21. Enter the date of signing.
22. Mail the completed form and any attachments to the address provided at the bottom of the form.

Complete your HI AMHD Contracts online to ensure a smooth transition for your agency.