Medicaid Non-emergency Medical Travel Authorization for the Use or Disclosure of Protected Health Information - South Dakota

Medicaid Non-emergency Medical Travel Authorization for the Use or Disclosure of Protected Health Information - South Dakota

Medicaid Non-emergency Medical Travel Authorization for the Use or Disclosure of Protected Health Information is a legal document that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota.

FAQ

Q: What is the Medicaid Non-emergency Medical Travel Authorization?
A: The Medicaid Non-emergency Medical Travel Authorization is a document that allows the use or disclosure of Protected Health Information for non-emergency medical travel purposes.

Q: Who is eligible for the Medicaid Non-emergency Medical Travel Authorization?
A: Individuals who are Medicaid recipients and require non-emergency medical travel are eligible for the Authorization.

Q: Why would someone need the Medicaid Non-emergency Medical Travel Authorization?
A: The Authorization is needed to ensure that Protected Health Information can be shared for the purpose of arranging and coordinating non-emergency medical travel.

Q: How can someone obtain the Medicaid Non-emergency Medical Travel Authorization?
A: To obtain the Authorization, individuals need to complete and submit the necessary form to the appropriate Medicaid agency in South Dakota.

Q: Is there a cost associated with the Medicaid Non-emergency Medical Travel Authorization?
A: No, there is no cost associated with obtaining the Authorization.

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Form Details:

  • Released on April 1, 2019;
  • The latest edition currently provided by the South Dakota Department of Social Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.

Download Medicaid Non-emergency Medical Travel Authorization for the Use or Disclosure of Protected Health Information - South Dakota

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