Louisiana Department of Health Forms

This document is used for placing a physician's order for Personal Directed Health Care (PDHC) in the state of Louisiana.

This form is used for requesting repair services for custom wheelchairs in the state of Louisiana.

This Form is used for requesting complex care in the state of Louisiana. It is used to document and submit the necessary information to receive specialized medical care or treatments.

This Form is used for requesting rehabilitation services in the state of Louisiana.

This form is used for requesting prior authorization for medical services in the state of Louisiana.

This form is used for requesting prior authorization for medical services in the state of Louisiana. It is important to complete this form in order to receive coverage for certain procedures or treatments.

This Form is used for requesting authorization for pediatric day health care services in Louisiana.

This form is used for submitting a prior authorization request for a transplant procedure in the state of Louisiana. It is necessary to obtain approval from the insurance provider before undergoing a transplant surgery.

This form is used for residents of Louisiana to request prior authorization for air ambulance services. It is required to ensure coverage and payment for the services rendered.

This Form is used for evaluating pediatric hospital beds in Louisiana.

This type of document provides information about hospital-based alcoholism and drug treatment units in Louisiana. These units offer specialized care and treatment for individuals struggling with alcoholism and drug addiction in a hospital setting.

This document provides the criteria for determining the length of stay at rehabilitation hospitals in Louisiana.

This form is used for requesting neonatal/newborn level of care assistance through the Medical Assistance Program in Louisiana.

This document outlines the criteria for admitting or extending the stay of children in psychiatric units in Louisiana.

This form is used for the admission of patients to inpatient psychiatric hospitals in Louisiana.

This document outlines the criteria for admission or extension of stay in a psychiatric unit for adults in the state of Louisiana.

This Form is used for requesting an extension or reconsideration for psychiatric or substance abuse treatment in the state of Louisiana.

This form is used for requesting an extension, resubmittal, reconsideration, or update for inpatient acute care in Louisiana.

This form is used for requesting prior authorization in the state of Louisiana. It helps individuals and providers to seek approval for specific medical services or treatments before receiving them.

This form is used for updating insurance information for Medicaid recipients who are covered under traditional Medicare in the state of Louisiana.

This Form is used for collecting contact information in the state of Louisiana. It may be used for various purposes such as registrations, applications, or updates.

This document provides a detailed guide for home health agencies in Louisiana to effectively respond to emergencies, ensuring patient safety and continuity of care during crisis situations.

This form is used for authorizing the use of palivizumab, a medication used to prevent serious respiratory infections, in the state of Louisiana.

This form is used for making adjustments to drug prescriptions in the Medical Assistance Program in Louisiana.

This Form is used for evaluating custom wheelchairs in Louisiana.

This form is used for obtaining a notarized export certificate in the state of Louisiana. It is required for exporting certain goods out of the state.

This form is used for obtaining a notarized export certificate in Louisiana. It is available in both English and Spanish languages.