Get Hi Dhs 1144 2014-2026

The HI DHS 1144 form is essential for requesting medical authorization from the State of Hawaii's Department of Human Services. This guide provides clear instructions for filling out the form online, ensuring that your request is submitted accurately and efficiently.

Follow the steps to complete the HI DHS 1144 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate the type of request you are submitting by checking only one box for 'Urgent Request', 'Extension Request', or 'New Request'.
3. Select the type of service you are requesting by checking the appropriate box under the 'Request for Medical Authorization' section. Remember, different types of services must be requested on separate 1144 forms.
4. Enter the patient's information, including their name, date of birth, and mailing address. Ensure that you clearly print all information.
5. Confirm the patient's current location by checking the appropriate box (Home, SNF/ICF, or Other).
6. Indicate whether the patient is receiving Medicare home health benefits.
7. Complete the supplier and physician sections by providing service descriptions, procedure codes, and quantities for requested items. Include purchase price and specify if it is a rent or repair.
8. Fill out the physician's comments and diagnosis, ensuring to provide justification if applicable.
9. Have both the physician and the supplier sign and date the form where indicated, ensuring to print their names and contact information.
10. Review the entire form for any missing information and confirm that all sections are completed before final submission.
11. Once completed, users can save changes, download, print, or share the form as needed.

Complete your HI DHS 1144 form online for a smoother authorization process.