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Fact sheet #5Maryland Medicaid Program
Permanent Sterilization Procedure
Medicaid FeeForService and CMOS are required to cover permanent sterilization procedures but only if
ALL the following conditions
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How to fill out permanent sterilization procedure

How to fill out permanent sterilization procedure
01
To fill out the permanent sterilization procedure form, follow these steps:
02
Obtain the form from your healthcare provider or download it from their website.
03
Read the instructions on the form carefully to understand the information required.
04
Provide your personal information such as name, address, date of birth, and contact details.
05
Answer the questions regarding your medical history, including any previous surgeries or medical conditions.
06
Provide details about your desired method of permanent sterilization, such as tubal ligation or vasectomy.
07
If necessary, provide information about your spouse or partner.
08
Sign and date the form.
09
Review the completed form for accuracy and ensure all required fields are filled.
10
Submit the form to your healthcare provider as per their instructions.
Who needs permanent sterilization procedure?
01
The permanent sterilization procedure is typically considered for individuals who:
02
- Do not want to have any or any more children in the future.
03
- Have completed their family planning and are certain about their decision.
04
- Want a long-term, highly effective method of contraception.
05
- Wish to avoid the risks and complexities associated with temporary contraceptive methods.
06
- Have discussed the procedure with their healthcare provider and fully understand its implications.
07
It is important to consult with a healthcare professional to determine if permanent sterilization is the right choice for you.
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What is permanent sterilization procedure?
Permanent sterilization procedure is a medical procedure that permanently prevents a person from having children.
Who is required to file permanent sterilization procedure?
Any individual who undergoes permanent sterilization procedure must file the necessary paperwork with the relevant authorities.
How to fill out permanent sterilization procedure?
To fill out permanent sterilization procedure, individuals must complete the required forms provided by the authority overseeing the procedure and submit any supporting documentation as needed.
What is the purpose of permanent sterilization procedure?
The purpose of permanent sterilization procedure is to provide a long-term or permanent solution for individuals who do not wish to have children.
What information must be reported on permanent sterilization procedure?
Information such as the individual's personal details, date of procedure, medical provider, and any related medical history may need to be reported on permanent sterilization procedure.
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