This article will help users with the form.

Form information

The form is included in the Consent for Release of Information and Medicaid Reimbursement event which is created by the user.

Contact your EPS with questions about completing this form.

Info
As of August, 2013, this is a one-time consent form. Once the form is signed, no new forms will be needed on an annual basis as before.

Completing the Release of Information and Medicaid Reimbursement Form

Enter Parent Name
If parent signed, enter the Parent Signature exactly as signed
Enter Date parent signed or, if the parent did not sign, enter the Date the form is being completed
Click Consent, No Consent or No Response
Save

Table of Contents