This version of the form is not currently in use and is provided for reference only. Download this version of the document for the current year.
Patient Eligibility Screening Record - Public Provider - Vaccines for Children Program is a legal document that was released by the Iowa Department of Health and Human Services - a government authority operating within Iowa.
Q: What is the Patient Eligibility Screening Record?
A: The Patient Eligibility Screening Record is a document used for screening patients for eligibility to receive vaccines under the Vaccines for Children Program in Iowa.
Q: What is the Vaccines for Children Program in Iowa?
A: The Vaccines for Children Program in Iowa is a program that provides vaccines to children who are eligible and cannot afford them.
Q: Who is eligible for the Vaccines for Children Program in Iowa?
A: Children who meet certain eligibility criteria, such as being uninsured, underinsured, or enrolled in Medicaid, are eligible for the Vaccines for Children Program in Iowa.
Q: What is the purpose of the Patient Eligibility Screening Record?
A: The purpose of the Patient Eligibility Screening Record is to determine if a patient is eligible to receive vaccines under the Vaccines for Children Program in Iowa.
Form Details:
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Iowa Department of Health and Human Services.