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Aetna 855.734.9389 (routine) / 855.734.9393 (expedited) Buckeye 866 694 3649 (Medicaid) / 877.725.7751 (Mylar) Resource 937.487.1664 / Molina 866.449.6843 Paramount 844.282.4901 / UHC 855.633.3306Ohio

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How to fill out ohio medicaidmycare authorization form

01

Obtain an Ohio MedicaidMyCare Authorization form from the Ohio Department of Medicaid or download it from their website.

02

Start by filling out the patient's personal information such as name, address, date of birth, and social security number.

03

Specify the date on which the authorization begins and ends.

04

Indicate the scope of the authorization by checking the appropriate boxes. This may include medical treatment, release of medical records, and communication with healthcare providers.

05

If necessary, provide additional details or instructions in the designated space.

06

Sign and date the form in the corresponding sections.

07

If the patient is unable to sign, a legal guardian or authorized representative may do so on their behalf.

08

Finally, submit the completed form to the appropriate entity or healthcare provider.

Who needs ohio medicaidmycare authorization form?

01

Ohio MedicaidMyCare authorization form is needed by individuals who wish to authorize medical treatment, release of medical records, and communication with healthcare providers on their behalf.

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