Form 165B Hospice Recipient Status Change - Alabama

Form 165B Hospice Recipient Status Change - Alabama

What Is Form 165B?

This is a legal form that was released by the Alabama Medicaid Agency - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 165B?
A: Form 165B is a hospice recipient status change form.

Q: What is the purpose of Form 165B?
A: The purpose of Form 165B is to report changes in the hospice recipient's status.

Q: Who should use Form 165B?
A: Form 165B should be used by hospices in Alabama.

Q: What information is required on Form 165B?
A: Form 165B requires information about the hospice recipient's name, Medicaid ID, and details of the status change.

Q: Are there any fees associated with Form 165B?
A: No, there are no fees associated with Form 165B.

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Form Details:

  • Released on October 1, 2021;
  • The latest edition provided by the Alabama Medicaid Agency;
  • 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 165B by clicking the link below or browse more documents and templates provided by the Alabama Medicaid Agency.

Download Form 165B Hospice Recipient Status Change - Alabama

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  • Form 165B Hospice Recipient Status Change - Alabama, Page 1
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