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This version of the form is not currently in use and is provided for reference only. Download this version of
Form SFN15
for the current year.
Form SFN15 Home Health / Extended Home Health Request for Service Authorization - North Dakota
What Is Form SFN15?
This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form SFN15 Home Health/ Extended Home HealthRequest for Service Authorization?
A: Form SFN15 is a document used in North Dakota to request authorization for home health or extended home health services.
Q: Who can use Form SFN15?
A: Form SFN15 can be used by individuals or healthcare providers who are seeking authorization for home health or extended home health services.
Q: What information is required on Form SFN15?
A: Form SFN15 requires information such as the patient's name, contact information, healthcare provider's information, requested services, and relevant medical details.
Q: What is the purpose of Form SFN15?
A: The purpose of Form SFN15 is to request authorization for home health or extended home health services in North Dakota.
Q: Is there a fee to submit Form SFN15?
A: There is no fee to submit Form SFN15. However, the cost of the services provided may be covered by insurance or other means.
Q: Who should I contact if I have questions about Form SFN15?
A: If you have questions about Form SFN15, you can contact the North Dakota Department of Human Services or consult with your healthcare provider.
Form Details:
- Released on August 1, 2014;
- The latest edition provided by the North Dakota Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form SFN15 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
