Form FA-94 Physician Certification of Terminal Illness - Nevada Medicaid Hospice Program - Nevada

What Is Form FA-94?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-94?
A: Form FA-94 is the Physician Certification of Terminal Illness for the Nevada Medicaid Hospice Program.

Q: What is the purpose of Form FA-94?
A: The purpose of Form FA-94 is to certify that a patient has a terminal illness and is eligible for the Nevada Medicaid Hospice Program.

Q: Who can complete Form FA-94?
A: The form must be completed by a physician who is caring for the patient and is familiar with their medical condition.

Q: What information is required on Form FA-94?
A: Form FA-94 requires the physician to provide details about the patient's terminal illness, prognosis, and anticipated life expectancy.

Q: Is there a deadline for submitting Form FA-94?
A: There is no specific deadline for submitting Form FA-94, but it is recommended to do so as soon as the patient meets the criteria for hospice care.