Medicaid Consent Form

Owned by Tracy Turner, created
Last updated: Jan 20, 2023 by William Johnson
1 min read

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.

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

  1. Enter Parent Name

  2. If parent signed, enter the Parent Signature exactly as signed

  3. Enter Date parent signed or, if the parent did not sign, enter the Date the form is being completed

  4. Click Consent, No Consent or No Response

  5. Save