Alabama Medicaid Agency Forms

This form is used for appointing a representative in Alabama for legal or financial matters.

This Form is used for the Baseline Screening Assessment in Alabama.

This form is used for evaluating the level of care required for individuals seeking institutional care in Alabama who have an Intellectual Disabilities (ID) and/or a related condition.

This form is used for evaluating the level of care for individuals with intellectual or developmental disabilities in Alabama. It helps determine the appropriate level of support needed for the individual.

This Form is used for conducting a wheelchair and seating evaluation in the state of Alabama. It is designed to assess the needs and requirements of individuals requiring mobility assistance.

This form is used for requesting wheelchair modification or repair services in Alabama.

This document is used for requesting a taxpayer identification number from individuals or businesses in Alabama.

This document is used for individuals and sponsors participating in the Alabama Gateway to Community Living program to acknowledge their understanding of program guidelines and responsibilities.

This form is used for referring individuals in Alabama to the Gateway to Community Living program, which provides support and resources for people with disabilities to live independently in their communities.

This form is used for submitting a dossier for Alabama Medicaid in the state of Alabama.

This Form is used for Medicaid beneficiaries in Alabama to elect hospice care and for physicians to certify their eligibility for hospice services.

This Form is used for obtaining consent for sterilization procedures in Alabama Medicaid.

This form is used for reporting changes in recipient information to the Alabama Medicaid Agency. It is necessary for recipients to keep their information up to date to ensure continued eligibility for Medicaid benefits.

This form is used for documenting the family planning assessment in the state of Alabama.

This form is used for prior review and authorization of dental requests in the state of Alabama.

This form is used for requesting an administrative review of an outdated Medicaid claim in the state of Alabama.

This form is used for obtaining consent from a patient in Alabama before performing a hysterectomy, which is the surgical removal of the uterus.

This form is used for obtaining the consent of Alabama Medicaid recipients for telemedicine services.

This document is used for family planning home visits in Alabama.

This Form is used for collecting biographical data and obtaining consent from individuals in the state of Alabama.

This Form is used for obtaining consent for family planning services in Alabama.

This form is used for establishing the agreement and terms between a nursing facility and a resident in the state of Alabama.

This form is used for certification and documentation related to abortion procedures in the state of Alabama.

This form is used for certifying the need for emergency admission to a psychiatric residential treatment facility in Alabama.

This document is used for attesting to the model of a residential treatment facility in the state of Alabama. It provides proof of compliance with certain regulations and standards.

This document is used for terminating the contract of a psychologist supervisor in Alabama.

This form is used for psychologists in Alabama to update their address information for supervision contract purposes.

This form is used for certifying the need for non-emergency admission to a psychiatric residential treatment facility in Alabama.

This document outlines the agreement between a supervisor and a client in Alabama, regarding the terms and conditions of supervision services. It specifies the roles and responsibilities of both parties during the supervision period.

This type of document is used for conducting a diagnostic intake interview in the state of Alabama. It is a tool used to gather information about a person's background, history, and current situation in order to assess their needs and determine appropriate services or interventions.

This form is used for requesting applied behavioral analysis treatment for individuals with autism spectrum disorder in Alabama.

This Form is used for attesting the recognition of a Patient-Centered Medical Home (PCMH) in Alabama.

This form is used for keeping track of a child's medical record in Alabama, specifically for the Early and Periodic Screening, Diagnostic and Treatment program (EPSDT).

This form is used for certifying the birth of a newborn in the state of Alabama.

This Form is used for requesting a Pcp Override in the state of Alabama.

This Form is used for obtaining consent for sterilization procedures through the Alabama Medicaid Agency in Alabama.

This Form is used for screening and intervention for STD and HIV risks in Alabama.