Get Hi Dhs 1144 2007-2025

Filling out the HI DHS 1144 form is an essential step in requesting medical authorization in Hawaii. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by marking the type of request you are submitting. Select only one option: 'Urgent Request', 'Extension Request', or 'New Request'.
3. Next, specify the type of service being requested by checking the appropriate box. Options include: 'BH – Psych. Testing/ & Detox', 'DM – Appl./DME/ Supplies', 'GT – Transportation', among others.
4. Fill in the Medicaid identification number and indicate whether the patient is receiving Medicare coverage by checking 'Yes' or 'No'.
5. Provide the patient's name, date of birth, and current residence status by selecting one of the options provided.
6. Complete the patient mailing address, ensuring that all information is printed clearly for processing.
7. In the supplier and physician sections, enter the required information such as service description, procedure codes, quantity, and purchase price.
8. Include necessary comments related to the physician's instructions, diagnosis, or justifications for the service request.
9. Both the physician and supplier must sign and date the form, providing their names and contact information.
10. Once all sections are completed, review the form for completeness and accuracy, then save any changes. You can choose to download, print, or share the completed form as required.

Complete your documents online today for a smoother processing experience.