PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
BHSF Form 96-A
for the current year.
BHSF Form 96-A Acknowledgment of Receipt of Hysterectomy Information - Medicaid Program - Louisiana
What Is BHSF Form 96-A?
This is a legal form that was released by the Louisiana Department of Health - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the BHSF Form 96-A?
A: The BHSF Form 96-A is an acknowledgement form related to the Medicaid program in Louisiana.
Q: What does the form acknowledge?
A: The form acknowledges the receipt of hysterectomy information.
Q: What is the purpose of the form?
A: The form is used to acknowledge that the recipient of Medicaid in Louisiana has received information about hysterectomy procedures.
Q: Who uses the BHSF Form 96-A?
A: The form is used by recipients of Medicaid in Louisiana who have received information about hysterectomy procedures.
Form Details:
- Released on May 1, 2006;
- The latest edition provided by the Louisiana Department of Health;
- 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 BHSF Form 96-A by clicking the link below or browse more documents and templates provided by the Louisiana Department of Health.
