Recipient Notice of Election / Revocation / Discharge / Transfer - Louisiana Medicaid Hospice Program - Louisiana

Recipient Notice of Election / Revocation / Discharge / Transfer - Louisiana Medicaid Hospice Program - Louisiana

Recipient Notice of Election/Revocation/Discharge/Transfer - Louisiana Medicaid Hospice Program is a legal document that was released by the Louisiana Department of Health - a government authority operating within Louisiana.

FAQ

Q: What is the Louisiana Medicaid Hospice Program?
A: The Louisiana Medicaid Hospice Program provides hospice care for eligible individuals in the state of Louisiana.

Q: What is a Notice of Election?
A: A Notice of Election is a form that must be completed and submitted to enroll an individual in the Louisiana Medicaid Hospice Program.

Q: What is a Notice of Revocation?
A: A Notice of Revocation is a form that must be completed and submitted to cancel or terminate an individual's enrollment in the Louisiana Medicaid Hospice Program.

Q: What is a Notice of Discharge?
A: A Notice of Discharge is a form that must be completed and submitted to discharge or remove an individual from the Louisiana Medicaid Hospice Program.

Q: What is a Notice of Transfer?
A: A Notice of Transfer is a form that must be completed and submitted to transfer an individual from one hospice provider to another within the Louisiana Medicaid Hospice Program.

Q: Who is eligible for the Louisiana Medicaid Hospice Program?
A: Eligibility for the Louisiana Medicaid Hospice Program is based on meeting certain criteria, including having a terminal illness and a life expectancy of six months or less.

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Form Details:

  • Released on March 1, 2012;
  • The latest edition currently provided by the Louisiana Department of Health;
  • 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 Louisiana Department of Health.

Download Recipient Notice of Election / Revocation / Discharge / Transfer - Louisiana Medicaid Hospice Program - Louisiana

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