Alabama Medicaid Agency Forms

This form is used for documenting and assessing a family's planning status and needs in Alabama.

This type of document is used for applying for the Medicaid Plan First Program in Alabama. It is necessary for individuals who are seeking healthcare coverage and assistance through the Medicaid program in the state.

This form is used for extended family planning counseling in Alabama.

This form is used for HIV counseling in Alabama Medicaid. It includes pre and post-test counseling for individuals with HIV.

This Form is used for submitting a complaint or grievance related to the Plan First/Family Planning Program in Alabama.

This form is used for obtaining authorization in Alabama for cochlear implants, which are medical devices used to assist people with severe hearing loss.

This form is used for collecting and evaluating admission data for individuals in Alabama.

This form is used for requesting action related to long-term care in Alabama.

This form is used for designating an administrator for an estate in the state of Alabama. It is used to legally appoint someone to handle the affairs of a deceased person's estate.

This form is used for conducting a tuberculosis (TB) screening checklist for individuals under the Home and Community-Based Services (HCBS) Waiver program in Alabama.

This document is used for guiding the administrator of an estate in Alabama on how to fill out the Estate Designation Form. It provides instructions and information on the requirements and steps involved in appointing an administrator for an estate.

This form is used for verifying employment or school attendance for private duty nursing in Alabama.

This form is used for making changes to the status of a hospice recipient in the state of Alabama.

This form is used for the admission and evaluation assessment of residents at Pace in Alabama.

This Form is used for requesting nursing facility rates in the state of Alabama.

This form is used for the assessment of individuals with disabilities in Alabama who are seeking community living services. It helps determine the level of support and services needed for them to transition back into the community.

This document provides assistance in completing the application form for Alabama residents. It is an appendix that offers support in Spanish.

This document is used for reporting changes in recipients of Alabama Medicaid Agency.

This document is required to grant permission to disclose personal health information in the state of Alabama. It allows individuals to authorize healthcare providers to share their medical information with specified individuals or organizations.

This form is used for individuals in Alabama to make a statement of claim or provide information as a claimant or other party in a legal case.

This document outlines the plan for transitioning a community in Alabama to a new phase or direction. It details the steps and strategies involved in managing this transition.

This form is used for placing a lien on medical payments made by the Alabama Medicaid Agency in Alabama.

This form is used for providing lien information in Alabama. It is a sample form that can be used to gather information about liens on a property.

This document is used for applying for a hardship waiver in the state of Alabama.

This checklist is used for post-death lien negotiations in Alabama. It provides a guide for handling liens and negotiating with creditors after a person's death.

This document is a private duty nursing agreement for the Technology Assisted (Ta) Waiver in Alabama. It outlines the terms and conditions for providing care to adults with technology assistance.

This form is used for nursing home discharge planning in Alabama. It is part of the MDS 3.0 Section Q, which focuses on the care transition process for residents.

This form is used for reporting insurance coverage changes to Alabama Medicaid in the state of Alabama.

This Form is used for recording class attendance in Alabama.

This form is used for referring patients in Alabama for medical treatment or services.

This document is used for requesting a refund for a check in Alabama.

This document is a request form that is used in the state of Alabama to request a redetermination review of an NCCI (National Council on Compensation Insurance) ruling by Gainwell, a third-party administrator.

This form is used for certifying the birth of a newborn in the state of Alabama.

This form is used for creating a Medicaid Agency Approved Qualifying Income Trust in Alabama.

This form is used for reporting adverse events in the state of Alabama. It allows individuals to submit information about any negative experiences or incidents they have encountered.