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AHC CCS MEDICAL POLICY MANUAL
POLICY 430 ATTACHMENT E AHC CCS EPS DT CLINICAL SAMPLE
TEMPLATES
NINE TO TWELVE YEARS OLD AHC CCS EPS DT CLINICAL SAMPLE TEMPLATE
Dateless Preprimary Care ProviderFirst
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How to fill out how to request epsdt
How to fill out how to request epsdt
01
Contact your child's healthcare provider to request an EPSDT screening.
02
Provide all necessary information and documentation requested by the healthcare provider.
03
Schedule an appointment for the EPSDT screening.
04
Attend the appointment with your child and participate in the screening process.
05
Follow any recommendations or referrals provided by the healthcare provider based on the screening results.
Who needs how to request epsdt?
01
Children who are enrolled in Medicaid or CHIP (Children's Health Insurance Program) may need to request an EPSDT screening.
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What is how to request epsdt?
EPSDT stands for Early and Periodic Screening, Diagnosis, and Treatment. To request EPSDT, individuals must contact their state's Medicaid program.
Who is required to file how to request epsdt?
Children under the age of 21 who are enrolled in Medicaid are required to request EPSDT.
How to fill out how to request epsdt?
To request EPSDT, individuals can contact their state's Medicaid program or healthcare provider for assistance.
What is the purpose of how to request epsdt?
The purpose of requesting EPSDT is to ensure that children receive necessary preventive and comprehensive healthcare services.
What information must be reported on how to request epsdt?
Information such as the child's name, age, Medicaid ID, and reason for the request must be reported on the EPSDT form.
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