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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 392
for the current year.
Form 392 Patient Consent Form for Hepatitis C Agents - Alabama
What Is Form 392?
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 392 Patient Consent Form for Hepatitis C Agents?
A: Form 392 is a consent form required by Alabama for patients receiving treatment with Hepatitis C agents.
Q: Who needs to fill out Form 392 Patient Consent Form for Hepatitis C Agents?
A: Any patient receiving treatment with Hepatitis C agents in Alabama needs to fill out this form.
Q: What is the purpose of Form 392?
A: The purpose of Form 392 is to obtain patient consent for treatment with Hepatitis C agents and to ensure the patient understands the potential risks and benefits of the treatment.
Q: Is there a cost to fill out Form 392?
A: There is usually no cost associated with filling out Form 392.
Q: Can I refuse to fill out Form 392?
A: Yes, you have the right to refuse treatment and therefore refuse to fill out Form 392, but it may affect your ability to receive treatment with Hepatitis C agents in Alabama.
Q: How should I submit Form 392?
A: Form 392 is typically submitted to the healthcare provider or medical facility where you are receiving treatment.
Q: What information is required on Form 392?
A: Form 392 typically requires personal information, medical history, and a signature to indicate patient consent.
Q: Is Form 392 specific to Hepatitis C agents?
A: Yes, Form 392 is specific to treatment with Hepatitis C agents in Alabama.
Form Details:
- Released on April 1, 2017;
- 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 printable version of Form 392 by clicking the link below or browse more documents and templates provided by the Alabama Medicaid Agency.
