
AM OF PROJECTS RECEIVING FEDERAL FUNDS . ■ CONSENT TO STERILIZATION ■ I have asked for and received information about sterilization from _________________________________. When I first asked for the (Doctor or Clinic) information, I was told that the decision to be sterilized is completely up to me. I was told that I could decide not to be sterilized. If I decide not to be sterilized, my decision will not affect my right to future care or treatment. I will not lose any help or benefits from .
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How to fill out the SD DSS-MS-146 online
The SD DSS-MS-146 is a crucial form for individuals seeking sterilization under Medicaid. This guide provides step-by-step instructions for completing the form online to ensure clarity and compliance with federal requirements.
Follow the steps to fill out the SD DSS-MS-146 accurately.
- Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- In the consent section, write the name of the doctor or clinic from which you received information about sterilization.
- Indicate your decision regarding sterilization, ensuring you understand that it is a permanent procedure.
- Specify the method of sterilization you are consenting to, clearly detailing the operation type.
- Provide your date of birth in the format Month/Day/Year.
- Sign the form using your full name and date the signature.
- If applicable, have an interpreter complete the interpreter's statement section. Include their name and the language used for interpretation.
- The person obtaining consent must fill out their details, including the recipient's name and the type of surgery, then sign and date the form.
- Finally, the physician must complete their statement section after the surgery, noting the date and type of surgery performed. They should also provide their signature and date.
- Review the completed form for accuracy. Once satisfied, users can save changes, download, print, or share the form as necessary.
Complete the SD DSS-MS-146 online to ensure your sterilization consent is properly documented.
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