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Get and Sign Form 96 2006-2022

Get and Sign Form 96 2006-2022

Get the louisiana form hysterectomy 2006 template, fill it out, eSign it, and share it in minutes.

Permanently incapable of reproducing. Medicaid payment for a medically indicated hysterectomy can be authorized only if: (1) the individual and her representative*, if any, are informed orally and in writing that the hysterectomy will render her permanently incapable of reproducing; and, (2) the individual and her representative* if any, have signed a written acknowledgment of receipt of that information. The written acknowledgment must be signed and dated prior to the operation and must be...
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