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Form SFN614 Physician Certification for Medically Necessary Hysterectomy and Member Acknowledgment of Sterility - North Dakota
What Is Form SFN614?
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 SFN614?
A: SFN614 is a form used in North Dakota for physician certification for a medically necessary hysterectomy and member acknowledgment of sterility.
Q: Who uses SFN614?
A: The form is used by physicians and patients in North Dakota.
Q: What is the purpose of SFN614?
A: The purpose of SFN614 is to document the physician's certification of a medically necessary hysterectomy and the patient's acknowledgment of sterility.
Q: What information is included in SFN614?
A: The form includes information about the patient, physician certification for the procedure, and the patient's acknowledgment of sterilization.
Q: Is SFN614 required for all hysterectomies in North Dakota?
A: No, SFN614 is only required for medically necessary hysterectomies where sterilization is intended.
Q: What should I do with SFN614 after filling it out?
A: Once filled out, SFN614 should be submitted to the patient's healthcare provider for processing.
Form Details:
- Released on October 1, 2019;
- 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 SFN614 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
Download Form SFN614 Physician Certification for Medically Necessary Hysterectomy and Member Acknowledgment of Sterility - North Dakota
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