LA BHSF Form 90-L 2008 free printable template

BHSF Form 90-L Rev. 12/08 Prior Issues Obsolete REQUEST FOR MEDICAL ELIGIBILITY DETERMINATION I. RECIPIENT INFORMATION A. Recipient s Name SS Medicaid B. Address City State Zip Code Parish C. Responsible Party/Curator Telephone Race Medicare Date of Birth D. What are/were the living arrangements Sex Relationship Own home Relative s home Other E* What previous institutional care including nursing facilities has this person received Facility Date F* What Home/Community-based services have been...

How to fill out LA BHSF Form 90-L

How to fill out LA BHSF Form 90-L

1. Gather necessary personal information including name, address, and contact details.
2. Review the sections of the form to understand what information is required.
3. Fill out the identification section clearly with accurate details.
4. Provide information about your healthcare provider if applicable.
5. Carefully read and complete any sections related to your health status and medical needs.
6. Double-check all entries for accuracy and completeness.
7. Sign and date the form where indicated.
8. Submit the form as instructed, either by mail or electronically.

Who needs LA BHSF Form 90-L?

1. Individuals seeking health benefits from the Los Angeles County Department of Health Services.
2. Patients needing to apply for or renew their enrollment in health programs.
3. Residents of Los Angeles who require assistance with health-related services.

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What is LA BHSF Form 90-L?

LA BHSF Form 90-L is a specific form used in Louisiana for the reporting of certain health and financial data pertaining to healthcare providers.

Who is required to file LA BHSF Form 90-L?

Healthcare providers in Louisiana, including hospitals and clinics, are required to file LA BHSF Form 90-L as part of their compliance with state health regulations.

How to fill out LA BHSF Form 90-L?

To fill out LA BHSF Form 90-L, providers must gather the required financial and patient data, enter it into the form accurately, and submit it according to the filing instructions provided by the Louisiana Department of Health.

What is the purpose of LA BHSF Form 90-L?

The purpose of LA BHSF Form 90-L is to collect vital health and financial statistics that help inform state health policy and ensure the proper allocation of healthcare resources.

What information must be reported on LA BHSF Form 90-L?

LA BHSF Form 90-L requires reporting on various metrics, including patient counts, revenue sources, expenses, and other operational data relevant to the healthcare provider's activities.