PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form SFN15
for the current year.
Form SFN15 Home Health / Extended Home Health Request for Service Authorization - North Dakota
What Is Form SFN15?
This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form SFN15 Home Health/ Extended Home HealthRequest for Service Authorization?A: Form SFN15 is a document used in North Dakota to request authorization for home health or extended home health services.
Q: Who can use Form SFN15?A: Form SFN15 can be used by individuals or healthcare providers who are seeking authorization for home health or extended home health services.
Q: What information is required on Form SFN15?A: Form SFN15 requires information such as the patient's name, contact information, healthcare provider's information, requested services, and relevant medical details.
Q: What is the purpose of Form SFN15?A: The purpose of Form SFN15 is to request authorization for home health or extended home health services in North Dakota.
Q: Is there a fee to submit Form SFN15?A: There is no fee to submit Form SFN15. However, the cost of the services provided may be covered by insurance or other means.
Q: Who should I contact if I have questions about Form SFN15?A: If you have questions about Form SFN15, you can contact the North Dakota Department of Human Services or consult with your healthcare provider.
Form Details:
- Released on August 1, 2014;
- The latest edition provided by the North Dakota Department of Health and Human 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 fillable version of Form SFN15 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
