PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form FA-16B
for the current year.
Form FA-16B Home Health Agency " Private Duty Nursing (Pdn) Services Only Prior Authorization Request - Nevada
What Is Form FA-16B?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form FA-16B?
A: Form FA-16B is a home health agency prior authorization request form specifically for Private Duty Nursing (PDN) services in Nevada.
Q: What are Private Duty Nursing (PDN) services?
A: Private Duty Nursing (PDN) services refer to skilled nursing care provided to patients in their homes.
Q: Is Form FA-16B applicable only to Nevada?
A: Yes, Form FA-16B is specific to Nevada and is used for requesting prior authorization for Private Duty Nursing (PDN) services in the state.
Q: What information is required in Form FA-16B?
A: Form FA-16B requires information such as patient details, physician information, diagnosis, duration of services requested, and justification for PDN services.
Q: What is the purpose of Form FA-16B?
A: The purpose of Form FA-16B is to request prior authorization for Private Duty Nursing (PDN) services in Nevada, ensuring that the services are medically necessary and appropriate.
Form Details:
- Released on July 1, 2019;
- The latest edition provided by the Nevada 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 FA-16B by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
Download Form FA-16B Home Health Agency " Private Duty Nursing (Pdn) Services Only Prior Authorization Request - Nevada
1
2
3
4
5
6
