Get the free AHCCCS EPSDT Tracking Form - phoenixhealthplan.com
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FORMS ARE FOR PHP MEMBERS ONLY AHC CCS EPS DT Tracking Form Order Sheet Group Name: Physician Name(s): Office Contact/Title: Office Phone: Office Fax: Address (shipping): City: State: Zip Code: ***DID
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How to fill out ahcccs epsdt tracking form
How to fill out ahcccs epsdt tracking form:
01
Start by gathering all the necessary information such as the child's name, date of birth, and AHCCCS identification number.
02
Fill out the top section of the form with the child's personal information, including their address, phone number, and primary care provider.
03
Proceed to the next section where you will need to provide details about the child's medical history, including any past hospitalizations, surgeries, or chronic conditions.
04
For each well-child visit, document the date, height, weight, blood pressure, and any developmental milestones achieved. This information helps track the child's growth and development over time.
05
If the child has received additional health screenings such as hearing or vision tests, make sure to indicate the dates and results in the corresponding sections of the form.
06
Don't forget to include any immunizations the child has received, including the dates and types of vaccines administered.
07
In case the child has any medical concerns or issues that need to be addressed, provide detailed information in the appropriate section of the form.
08
Lastly, review the completed form for accuracy and make any necessary corrections before submitting it to the appropriate AHCCCS office.
Who needs ahcccs epsdt tracking form:
01
Families with children who are enrolled in AHCCCS, Arizona's Medicaid program, may need to fill out the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) tracking form.
02
The form is usually required for children under the age of 21 who receive healthcare services through AHCCCS.
03
Healthcare providers, including primary care physicians, specialists, and clinics, may also need the EPSDT tracking form to ensure comprehensive care and monitor the child's health and development over time.
04
The form is an essential tool for tracking and documenting the child's progress, ensuring they receive necessary screenings, immunizations, and treatments as recommended by AHCCCS guidelines.
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What is ahcccs epsdt tracking form?
The AHCCCS EPSDT tracking form is a form used to monitor and track the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services provided to AHCCCS members.
Who is required to file ahcccs epsdt tracking form?
Healthcare providers and facilities who provide EPSDT services to AHCCCS members are required to file the AHCCCS EPSDT tracking form.
How to fill out ahcccs epsdt tracking form?
The AHCCCS EPSDT tracking form can be filled out electronically or manually, and must include information such as member details, services provided, and screening results.
What is the purpose of ahcccs epsdt tracking form?
The purpose of the AHCCCS EPSDT tracking form is to ensure that AHCCCS members receive necessary preventive and developmental health services in a timely manner.
What information must be reported on ahcccs epsdt tracking form?
The AHCCCS EPSDT tracking form must include information on the screenings conducted, any diagnosis made, and the services provided to the AHCCCS member.
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