HHS-687 2010 free printable template

Form Approved: OMB No. 0937-0166 Expiration date: 12/31/2012 CONSENT FOR STERILIZATION NOTICE: YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY

How to fill out HHS-687

How to fill out HHS-687

1. Begin by downloading the HHS-687 form from the official website.
2. Fill in your personal information in the designated sections, including your name, address, and contact details.
3. Provide information about your healthcare services or programs that you are involved with.
4. Indicate the type of assistance you are applying for or reporting.
5. Attach any required documentation supporting your application or report.
6. Review the completed form for accuracy and completeness.
7. Submit the form as instructed, either electronically or by mail.

Who needs HHS-687?

1. Individuals or organizations seeking assistance or benefits from health and human services.
2. Healthcare providers reporting on their service delivery or compliance.
3. Non-profit organizations applying for funding or support from HHS programs.

People Also Ask about

How old do you have to be to get your tubes tied in Louisiana?

You can have a tubal ligation at any time. If you are interested in getting a tubal ligation, talk with your doctor or clinic. For Medicaid or other federal programs to pay for a tubal ligation, you must be 21 years of age and have signed a consent form giving permission 30 days before the procedure.

What consent is required for sterilization?

STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.

Can you get your tubes tied in Louisiana?

How do you get your tubes tied in Louisiana? You can get a tubal ligation at a doctor's office, hospital, or health clinic. Many Planned Parenthood health centers also do some types of sterilization procedures.

What is covered under Louisiana Medicaid?

LaCHIP provides Medicaid coverage for primary care doctor visits as well as preventive and emergency care, immunizations, prescription medications, hospitalization, home health care and other health services.

What are the different types of Louisiana Medicaid plans?

Those contracts are with the five existing health plans - Aetna Better Health of Louisiana, Amerihealth Caritas Louisiana, Healthy Blue, Louisiana Healthcare Connections and UnitedHealthcare Community Plan.

What is the monthly income limit for Medicaid in Louisiana?

As an example, the 2023 income limits for eligibility for adults 19 to 64 without Medicare were $1,562 per month for a single individual and $3,191 per month for a family of four. The current income limits can be found on the Louisiana Medicaid Eligibility Income page.

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What is HHS-687?

HHS-687 is a report form used by certain health and human services organizations to provide necessary data for compliance and monitoring purposes.

Who is required to file HHS-687?

Organizations that receive federal funding or grants from the Department of Health and Human Services (HHS) are typically required to file HHS-687.

How to fill out HHS-687?

HHS-687 should be filled out by providing information as specified in the form instructions, which usually include sections on organizational details, funding received, and performance metrics.

What is the purpose of HHS-687?

The purpose of HHS-687 is to collect standardized data to evaluate the effectiveness and to ensure accountability of funded programs and services.

What information must be reported on HHS-687?

Information that must be reported typically includes the entity's name, contact information, funding amounts, program activities, and outcomes achieved during the reporting period.