Alabama Medicaid Agency Forms

This document is an application for presumptive eligibility for Medicaid at hospitals in Alabama. It helps determine if you qualify for immediate health care coverage while your full Medicaid application is being processed.

This form is used for determining eligibility for preliminary hospital coverage in Alabama. It also includes an agreement regarding the code of conduct for the applicants.

This Form is used for requesting prior authorization and prescription for oxygen therapy in Alabama.

This form is used for applying for Hospital Presumptive Eligibility (HPE) in Alabama. It is specifically for healthcare providers to verify their status and agree to the terms of the program.

This form is used for collecting contact information of pharmaceutical manufacturers in Alabama. It helps in maintaining a database of businesses in this industry for communication and collaboration purposes.

This form is used for requesting a change in prior authorization for the Form 471 program in Alabama.

This document is used for evaluating and reporting on an augmentative communication device in the state of Alabama. It helps to assess the effectiveness and suitability of the device for individuals with communication needs.

This form is used for enrolling providers in the EPSDT program in Alabama. The program provides comprehensive and preventive healthcare services for children who are Medicaid eligible.

This form is used for creating a legal agreement to sell property in the state of Alabama. It outlines the terms and conditions of the sale and must be signed by both the buyer and the seller.

This form is used for a Spousal Allocation Agreement in Alabama.

This Form is used for making a statement about a claimant or other person's burial fund designation in the state of Alabama.

This document is for the certification of physiological laboratories in the state of Alabama through the Provider Web Portal Application.

This form is used for electronically delivering documents in the state of Alabama. It allows individuals or businesses to send important information or files digitally, without the need for physical delivery.

This form is used for providing individual disclosure information in the state of Alabama. It contains personal information and disclosures required by the state law.

This Form is used for requesting a change of ownership in the state of Alabama.

This document is used for authorizing electronic financial transactions with Alabama Medicaid in the state of Alabama.

This form is used for updating information about out-of-state ambulatory surgical centers and hospitals in Alabama. It allows for keeping records of these facilities and their current status.

This form is used for conducting a security risk analysis to ensure compliance with regulations in Alabama.

This document is used for notifying the intention to conduct a self-audit by a provider in Alabama.

This Form is used for obtaining the consent of parents or guardians in Alabama.

This Form is used for requesting medical records in the state of Alabama.

This document is used for applying for health coverage and financial assistance for healthcare costs in the state of Alabama.

This form is used in Alabama for overriding the cumulative daily morphine milligram equivalents (MME) limit.

This Form is used for requesting Child Growth Hormone/Turner Syndrome, Prader-Willi Syndrome, Noonan Syndrome coverage in Alabama.

This type of document is used for requesting a pharmacy override for Medicaid in Alabama.

This Form is used for requesting assistance for growth failure in individuals with AIDS wasting. It is specific to the state of Alabama.

This form is used for requesting adult growth failure pa in the state of Alabama.

This Form is used for requesting hepatitis C antiviral agents in Alabama.

This form is used for requesting prior authorization for DMARD/biological injectables in the state of Alabama.