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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DSS-NEMT-973
for the current year.
Form DSS-NEMT-973 South Dakota Medicaid Non-emergency Medical Travel Appointment Verification Form - South Dakota
What Is Form DSS-NEMT-973?
This is a legal form that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSS-NEMT-973?
A: DSS-NEMT-973 is the South Dakota Medicaid Non-emergency Medical Travel Appointment Verification Form.
Q: What is the purpose of DSS-NEMT-973?
A: The purpose of DSS-NEMT-973 is to verify non-emergency medical travel appointments for South Dakota Medicaid recipients.
Q: What information is required on DSS-NEMT-973?
A: DSS-NEMT-973 requires the Medicaid recipient's information, appointment details, and signature of the authorized representative.
Q: Who needs to fill out DSS-NEMT-973?
A: DSS-NEMT-973 needs to be filled out by the authorized representative of the Medicaid recipient who is using non-emergency medical travel services.
Form Details:
- Released on December 1, 2021;
- The latest edition provided by the South Dakota Department of Social 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 printable version of Form DSS-NEMT-973 by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.
