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  • Hi Dhs 1139a 2013

Get Hi Dhs 1139a 2013-2025

LING ATTACHMENT 1. Name: 2. Business Address: 3. 4. 5. 6. 7. 8. 9. First Middle Last Number Street Suite City State/Country City State/Country Zip Code Place of Birth: Telephone Number Birth Date: | | Month/Day/Year Are you a resident of Hawaii? Yes No How long: Have you been certified or licensed to practice medicine/psychology in another State? Yes No If “YES,” what State(s): Have you ever been denied a certificate or license as a practicing physician/psychologist? .

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How to fill out the HI DHS 1139A online

The HI DHS 1139A form is an essential document for psychiatry and psychology credentialing in Hawaii. This guide will help you navigate the online filling process seamlessly.

Follow the steps to complete the HI DHS 1139A form online.

  1. Click 'Get Form' button to access the HI DHS 1139A and open it for editing.
  2. Begin by entering your name in the designated fields for first, middle, and last names. Ensure accuracy as this information is crucial for identification.
  3. Provide your business address. Fill in the necessary details including the street number, street name, suite number (if applicable), city, state/country, and zip code.
  4. Complete the section regarding your place of birth. It is important for demographic and identification purposes.
  5. Enter your telephone number to ensure that the reviewing authority can contact you if needed.
  6. Input your birth date in the specified format (month/day/year). Double-check the format to avoid any errors.
  7. Indicate whether you are a resident of Hawaii by selecting 'Yes' or 'No.' If 'Yes,' note how long you have been a resident.
  8. Provide information regarding your medical/psychology certification or licensing in other states. Indicate if you have been denied a certificate or if any license has been suspended or revoked.
  9. Fill out the education and experience sections accordingly. List the institutions and employers in reverse chronological order, including your major course of study, graduation dates, and duties performed.
  10. Indicate your status regarding the American Board of Examiners in Professional Psychiatry and Neurology and any affiliations with hospitals or clinics.
  11. Finally, review all entered information for accuracy, then provide your signature and date signed at the bottom of the form.
  12. Once all fields are completed, save your changes, download a copy for your records, and be prepared to print or share the form as necessary.

Take the next step in your credentialing process by completing the HI DHS 1139A form online today.

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To qualify for Medicaid Quest in Hawaii, individuals must meet specific income and eligibility requirements set by the state. Generally, these requirements assess both income levels and family size, ensuring proper access to healthcare services. For the most current qualifications and guidelines, visiting the HI DHS 1139A can provide you with accurate and detailed information. Understanding these criteria can help you or your loved ones gain crucial healthcare assistance.

If you need to speak with someone from Medicaid, you can call the HI DHS 1139A support line. They have trained representatives available to assist you with your queries regarding eligibility, benefits, and more. Alternatively, you may also connect with local offices that provide face-to-face assistance. It’s important to have your details handy for a smoother conversation.

To reach the Medicaid provider in Hawaii, you can call the HI DHS 1139A hotline. This dedicated line provides assistance with a variety of Medicaid-related inquiries. Make sure to have your information ready when you call, as this can help expedite your experience. The representatives are ready to assist you with any questions you may have about your Medicaid services.

Filling out a medical authorization form requires careful attention to detail. Start with accurate personal information like your name and contact details. Next, specify what information you are authorizing for release, and ensure that you understand how this relates to the HI DHS 1139A regulations. For additional help and access to templates, USLegalForms offers easy-to-use resources that simplify the completion of these important documents.

Becoming an Iowa Medicaid provider involves submitting an application to the Iowa Department of Human Services. You must review and meet the specific credentialing requirements for your profession. Staying informed about regulations such as HI DHS 1139A will aid your application process, ensuring you deliver significant health services to Iowans effectively. For guidance, consider using platforms like uslegalforms, which can assist with necessary documentation.

To become a Medicaid provider in Idaho, you need to complete an application with the Idaho Department of Health and Welfare. This process includes providing detailed information about your practice and relevant qualifications. It’s essential to familiarize yourself with the requirements linked to HI DHS 1139A, as ensuring compliance with these standards can streamline your provider enrollment and help you offer valuable services to Idaho residents.

To qualify for Medicaid in Hawaii, or Med-QUEST, individuals and families must meet certain income limits based on federal poverty guidelines. This is assessed on an annual basis, so it’s essential to check the most current figures. Resources related to HI DHS 1139A can help you determine if you meet these income requirements and explore your health coverage options.

The two main types of Medicaid are the Expansion Medicaid and the Traditional Medicaid. Expansion Medicaid is available to a broader range of income levels, while Traditional Medicaid may have stricter eligibility requirements. Understanding these distinctions can guide you toward the right health coverage, especially in the context of HI DHS 1139A.

Yes, Med-QUEST is indeed Hawaii's version of Medicaid. This program provides crucial health services to low-income residents, helping them receive necessary medical assistance. By understanding Med-QUEST and its connection to HI DHS 1139A, you can better navigate your healthcare options in Hawaii.

Med-QUEST is the Medicaid program specifically designed for Hawaii, providing comprehensive health coverage to eligible residents. While both programs offer essential health services, Med-QUEST focuses on the unique needs of Hawaii’s population, ensuring access to care through various local providers. If you're exploring options under HI DHS 1139A, understanding this distinction is vital.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232