Arkansas Department Of Health Forms

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Forms Arkansas Department of Health

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3 hours ago Forms; Forms *NOTICE* Due to the ongoing fight against COVID-19, the Plumbing and Food Service Plan Review section of the Arkansas Department of Health is encouraging plan submissions to be sent electronically via our online plan portal or by Mail or delivery service.

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HealthCare Decision Forms Arkansas Department of Health

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4 hours ago HealthCare Decision Forms. Below are the Health Care Decision Forms that were adopted by the Board of Health on October 24, 2013 pursuant to the Health Care Decisions Act (Act 1264 of 2013). Act 504 of 2017 Arkansas Physician Order for Life-Sustaining Treatment Act (POLST) provides a standardized physician order form.

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ASBN Forms Arkansas Department of Health

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9 hours ago Education Department Online Application Additional Documents Cover Page. Employment Verification Form. Individual Offering Approval Form. Program RN/PN Verification. Special Accommodation for NCLEX® Exam Information and Request Form. Disciplinary. Aftercare Meetings Report. Employer Acknowledgement. Enforcement Treatment Provider Report.

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Water System Forms Arkansas Department of Health

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5 hours ago Water System Operating Report Form (Short Form) SWTR Operation Report Form. Individual Filter Monitoring for 10,000 population or more. Individual Filter Monitoring under 10,000 population. Revised Total Coliform Rule Summary. RTCR Level 1 Assessment Form. Supplemental Surface source systems with Cartridge-Bag Filters Form.

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Forms & Documents Arkansas Department of Human …

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4 hours ago Demonstration waivers – https://humanservices.arkansas.gov/divisions-shared-services/medical-services/demonstration-waiver-projects/ Medicaid Data and Reports for

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Forms Arkansas

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2 hours ago This application includes the Physician Written Certification form. This form is to be filled out by a Physician to certify a qualifying medical condition. This form must be submitted online, or mailed to the Arkansas Department of Health, along with a completed and paid application within 30 days of physician's signature. (Revised 02-11-2020)

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Forms & Documents Arkansas Department of Human …

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6 hours ago 24 rows · DHS-8506 MFP Assessment and Personal History Form. PDF. 05/08/2019. DHS …

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Arkansas Department of Health

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3 hours ago Certificates & Records. Get Your Vital Records, including birth, death, marriage and divorce, change a certificate or submit a new record for registration.

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Forms & Instructions Arkansas Insurance Department

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800.282.9134Just Now Regulatory Health Link (IPA Guide, Navigator, Certified Application Counselor, Exchange Producer) Visit Arkansas.gov Governor's Office. Arkansas Insurance Department. 1 Commerce Way Little Rock, AR 72202. 800.282.9134 or 501.371.2600 Fax: 501.371-2618.

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Arkansas Department of Health

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(501)-372-50716 hours ago Arkansas Department of Health José R. Romero, MD, Secretary of Health Social Work Licensing Board Ruthie Bain, Director Mailing Address: P. O. Box 251965, Little Rock, AR 72225 Street Address: Freeway Medical Tower, 5800 West 10th, Suite 100, Little Rock, AR 72204 Telephone (501)-372-5071 Fax (501)372-6301

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Arkansas Department of Health

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(501) 372-50716 hours ago Arkansas Department of Health Social Work Licensing Board 5800 West 10th, Suite 100, Little Rock, AR 72204 * (501) 372-5071 * Fax (501) This form is not necessary for Arkansas license verification. 5. Have you ever been denied a professional license, certification or in Arkansas or any other state or

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Arkansas Department of Health

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(501) 372-50715 hours ago Arkansas Department of Health Social Work Licensing Board th5800 West 10 , Suite 100, Little Rock, AR 72204 * (501) 372-5071 * Fax (501) 372-6301 Mailing Address: P. O. Box 251965, Little Rock, AR 72225

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Arkansas Department of Health

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(501)-372-5071Just Now Arkansas Department of Health José R. Romero, MD, Secretary of Health Social Work Licensing Board Ruthie Bain, Director Mailing Address: P. O. Box 251965, Little Rock, AR 72225 Street Address: Freeway Medical Tower, 5800 West 10th, Suite 100, Little Rock, AR 72204 Telephone (501)-372-5071 Fax (501)372-6301

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ARKANSAS DEPARTMENT OF HEALTH & HUMAN SERVICES

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7 hours ago ARKANSAS DEPARTMENT OF HEALTH INFLUENZA SEASON -- IMMUNIZATION CONSENT FORM Person Receiving Vaccine: FORM 4056 Revised 7/28/21 Flu Vaccine Route Site Code Dosage mL MFG Code Lot Number IM Site Codes: Right Deltoid = RD, Left Deltoid = LD, Right Leg = RL, Left

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Request a Child Maltreatment Check Arkansas Department

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1 hours ago Stage 2: Arkansas (AR) Child Maltreatment Central Registry Form Upload Process. Scan the notarized form to your computer and save it to a place you can easily locate it. Once you have your form saved, access the Central Registry Form Uploader to send your file to the Central Registry Team using the links below: You can upload a single request here.

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Arkansas Immunization Exemption

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(501) 661-20002 hours ago Arkansas Department of Health. 4815 West Markham Street Little Rock, Arkansas 72205-3867 Telephone (501) 661-2000. Arkansas Immunization Exemption Application. The Arkansas Board of Health requires that all children attending childcare facilities and public or private schools in the State of Arkansas be immunized against vaccine-preventable

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Health Screening Form Arkansas Department of Education

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4 hours ago Arkansas Department of Human Services. Division of Child Care and Early Childhood Education. To Parent or Guardian: In order to provide the best learning experience for your child, teacher must understand your child’s health needs. State regulations require any child enrolled in the Arkansas Better Chance Pre-K program to have a well child

Author: pwlazenby
Last modified by: Sherrill Archer
Created Date: 6/17/2015 5:33:00 PM
Title: Health Screening Form

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Arkansas Department of Health (ADH) Arkansas Department

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9 hours ago The following documents are available for this provider type. See also All Providers. Notices of Rule Making Date Number Subject None – – Official Notices Date Number Subject 11/22/21 ON-024-21 2021 Fourth (4th) Quarter Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) 4/8/21 ON-009-21 2021 Third …

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Arkansas Department of Health Home Arkansas.gov

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3 hours ago Arkansas Department of Health. menu; ABOUT ADH; RULES AND REGS; NEWS; RESOURCES & PUBLICATIONS; A-Z TOPICS; HEALTH UNITS; 2020 Consumer Confidence Reports. Public Health Safety. Animal Exhibits ; Arkansas Public Health Laboratory Rabies Laboratory Services Water System Forms ;

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Section V Forms and Contacts Arkansas

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2 hours ago section V – FORMS. 500.000 Claim Forms Red-ink Claim Forms. The following is a list of the red-ink claim forms required by Arkansas Medicaid. The forms below cannot be printed from this manual for use. Information about where to get the forms and links to samples of the forms is available below. To view a sample form, click the form name.

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Medical Marijuana Program Arkansas

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501-682-49829 hours ago If you have any questions throughout the application process, please contact the Medical Marijuana Section at 501-682-4982. Please allow all applications up to 14 business days for processing. Effective July 28, in accordance with Act 1028 of 2021, visiting patient Registry Identification Cards will expire after 90 days.

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Arkansas Department of Health

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(501)-372-50711 hours ago Arkansas Department of Health José R. Romero, MD, Secretary of Health Social Work Licensing Board Ruthie Bain, Director Mailing Address: P. O. Box 251965, Little Rock, AR 72225 Telephone (501)-372-5071, Fax (501)372-6301 Street Address: Freeway Medical Tower, 5800 West 10th, Suite 100, Little Rock, AR 72204

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Arkansas Department of Health

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(501) 982-15386 hours ago Submitter: White, Jacob: Organization: Bond Consulting Engineers: Address: 2601 T.P. White Dr. City: Jacksonville: State: AR: Zip: 72076-Phone Number: (501) 982-1538

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CDC COVID19 Vaccination Program Provider Agreement

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4 hours ago Please click here or use the link below to submit a COVID-19 provider agreement form to the Arkansas Department of Health. You can also print a CDC provider agreement form here to help you gather the necessary information, but you must enter the data into the electronic form in order to submit it to ADH .

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Arkansas Department of Health

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4 hours ago I agree – That this obligates the above exam applicant to the below requirements: · If this is first time taking the above requested exam, a license application and $35.00 fee is required. · If this exam registration is to repeat the above requested exam, a $25.00 fee is required. Please use the re-exam fee, billing invoice provided with your previous exam results to submit the fee.

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Child Health Services/Early and Periodic Arkansas

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8 hours ago The Arkansas Department of Health oversees the VFC program in Arkansas. To enroll in the VFC Program and obtain the vaccines, providers may contact the Arkansas Department of Health. View or Print the Arkansas Be Well Referral Form. Refer to Section 257.000 and Section 292.900 of the Physician’s manual for more information. 215.300

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Arkansas Department of Health

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(501) 372-50711 hours ago Updated 9/14/2021 Arkansas Department of Health Social Work Licensing Board 5800 West 10th, Suite 100, Little Rock, AR 72204 * (501) 372-5071 * Fax (501) 372-6301 Mailing Address: P. O. Box 251965, Little Rock, AR 72225

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Arkansas Department of Health

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(501)-372-50715 hours ago Arkansas Department of Health Nathaniel Smith, MD, MPH, Secretary of Health Social Work Licensing Board Ruthie Bain, Director Mailing Address: P. O. Box 251965, Little Rock, AR 72225 Street Address: Freeway Medical Tower, 5800 West 10th, Suite 100, Little Rock, AR 72204 Telephone (501)-372-5071 Fax (501)372-6301

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Paternity Department of Finance and Administration

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3 hours ago AOP forms are also available through the Arkansas Department of Health, and any local Office of Child Support Enforcement. If the mother was married to someone other than the biological father at the time of birth, an AOP can be completed by the mother, husband/ex-husband, and the biological father.

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Arkansas Department of Health Home Arkansas.gov

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(501) 661-26232 hours ago STAFF LIST. Engineering Section staff can be reached by telephone by calling (501) 661-2623 [Fax (501) 661-2032]. Working hours are 8:00 AM to 4:30 PM, Monday through Friday.

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Apply For Services Arkansas Department of Human Services

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4 hours ago Health Care, SNAP, and TEA. For most DHS public assistance programs, you can apply online. To apply for food assistance through the Supplemental Nutrition Assistance Program (SNAP), cash, and other supports through the Transitional Employment Assistance (TEA) program, or Medicaid, ARKids, TEFRA, and health care under other categories of Medicaid, go to …

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Forms Arkansas Department of Corrections

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Just Now Unless otherwise noted, all documents below are in PDF format. Employment Transfer Form – DOC Rehire Application – DOC Training IA Training Form – DOC CJI Enrollment Form – DOC In-Service Enrollment Form – DOC Human Resources W4 – Employee Withholding Allowance Certificate AR4EC – State Employee’s Withholding Exemption Certificate Direct Deposit Form

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Welcome to the Arkansas Special Nutrition Program

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2 hours ago Representatives of federal and state administering agencies and the sponsoring organization (if applicable) observe and will work with the staff in your organization to improve your operation. You may contact SNP by writing to: Special Nutrition Programs, P.O. Box 1437, Slot S155, Little Rock, AR 72203-1437, or you may call (501)682-8869 or

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Provider Enrollment Application Packet Arkansas

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9 hours ago Upon request, the provider must furnish all records described in the provider contract within thirty-five (35) days of the date on a request by the Department, the Medicaid Fraud Control Unit, the Arkansas Office of the Medicaid Inspector General, or the U.S. Secretary of the Department of Health and Human Services or a designated agent or

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Section of Emergency Medical Services Arkansas eartment of

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204-1763 501Just Now Sub Topic: Regulatory Section Name: Forms Arkansas Department of Health 5800 West 10th Street Suite 800 Little Rock, Arkansas 72204-1763 501-661-2262 Center & Section: Center for Health Protection Emergency Medical Services

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Arkansas Department of Health Home Arkansas.gov

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2 hours ago Only samples received by the Arkansas Department of Health Laboratory in the past 30 days are shown. Raw water samples are not shown. Construction samples not submitted under the water system's ID number are also not shown.

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Persons With Disabilities Placard Department Arkansas

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8 hours ago By Mail: Department of Finance and Administration Special License Unit P O Box 1272 Little Rock, AR 72203Â In Person: Revenue Division Special License Unit Ragland Building 1900 West 7th Street Little Rock, AR 72201

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Arkansas Department of Health

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Just Now Date Time Location Site Address Select This Exam Site; 3266: 3/3/2022: 09:00:00: Mtn. Home: Baxter Co OEM Training Facility, 170 Dillard Dr, Midway: Select: 3267

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Adult Maltreatment Registry Background Check Request

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9 hours ago The completed request form will be emailed to the email address you entered on the AR Adult Maltreatment Registry Request Form website. Print this form and sign the completed copy in the presence of a notary. Stage 2: Arkansas (AR) Adult Maltreatment Registry Form Upload Process

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Health Department Forms

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7 hours ago Laboratory Personnel Excel Spread Sheet. Instructions for Completing the Application for a Clinical Lab License. (Updated Oct. 10, 2017) pdf 41k. doc 57k. CL-8. Blood Bank Annual Statistics (Out of Hospital and Emergency Only Transfusion Facilities) pdf 18k. doc 34k.

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Arkansas Department of Health

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1 hours ago Arkansas Department of Health. menu; ABOUT ADH; RULES AND REGS; NEWS; RESOURCES & PUBLICATIONS; A-Z TOPICS; HEALTH UNITS; ID Available Exams Select This Exam; 1: Grade 1 Distribution License: D-1: Select: 2: Grade 2 Distribution License: D-2: Forms ; Health Facility Services

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Financial Checklist Arkansas Insurance Department

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501-371-26805 hours ago ARKANSAS INSURANCE DEPARTMENT. FINANCE DIVISION. 1 Commerce Way, Suite 505. Little Rock, AR 72202-2087. For any questions on filing requirements below, please e-mail the Finance Divison or call 501-371-2680. The Department has discontinued production of the Annual Satement Reporting Guidance Letter for our Domestic Insurers.

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HVACR Arkansas Department of Labor and Licensing

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4 hours ago HVAC/R (Heating, Ventilation, Air Conditioning, & Refrigeration) The Department of Labor and Licensing provides consultation to local public health officials, architects, engineers, and other construction related offices regarding heating, ventilation, air conditioning and refrigeration. We supervise the inspection program for newly constructed public and private facilities throughout …

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The following information on Exemptions is from Arkansas

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2 hours ago Arkansas Department of Health, 4815 West Markham - Mail slot 48 Little Rock, AR 72205. The Medical Director will decide whether to grant the medical exemption based on the CDC guidelines. PLEASE NOTE: Incomplete forms will be returned for completion. A new Exemption Form Must Be Completed Every School Year.

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www.healthy.arkansas.gov

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3 hours ago Early Hearing Detection and Intervention Performance. Resources. 2019 Infant Hearing Program Infographic; Electronic Case Reporting (eCR) The Arkansas Department of Health is acti

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Communicable Disease Reporting Form Arkansas Department

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4 hours ago Arkansas Department of Health Communicable Disease Reporting Form Fax Reports to (501) 6612428 4815 West Markham Street, Slot #32 Little Rock, AR 72205 Please Print Legibly Reporting facility: Address:.

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Frequently Asked Questions

What are the health care decision forms in Arkansas?

Below are the Health Care Decision Forms that were adopted by the Board of Health on October 24, 2013 pursuant to the Health Care Decisions Act (Act 1264 of 2013). Act 504 of 2017 Arkansas Physician Order for Life-Sustaining Treatment Act (POLST) provides a standardized physician order form.

How do I contact the Arkansas Department of Finance and administration?

By Mail: Department of Finance and Administration Special License Unit P O Box 1272 Little Rock, AR 72203Â In Person: Revenue Division Special License Unit Ragland Building 1900 West 7th Street Little Rock, AR 72201

What forms do hospitals use in Arkansas for billing?

Professional – CMS-1500 Business Form Supplier Institutional – CMS-1450* Business Form Supplier * For dates of service after 11/30/07 – ALL HOSPICE PROVIDERS USE ONLY FORM CMS-1450 (formerly UB-04) for billing. Claim Forms The following is a list of the non-red-ink claim forms required by Arkansas Medicaid.

Do you have to sign an AOP in Arkansas?

No. If the child was born in Arkansas, the parents may sign the AOP form in front of a notary public and then mail it to the address on the cover of the form. What about child support and government assistance? Signing the AOP does not initiate child support or government assistance services.

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