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Medicaid | Department of Health | State of Louisiana

    https://www.lamedicaid.com/provweb1/Forms/Online_Forms.htm
    May 31, 2020

Informational Bulletin 22-9: Sterilization Consent Form | Louisiana ...

    https://www.louisianahealthconnect.com/newsroom/informational-bulletin-22-9--sterilization-consent-form.html
    Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date of April 30, 2022, on …

CONSENT FOR STERILIZATION

    https://www.lamedicaid.com/provweb1/Forms/Sterilization_Consent.pdf
    (2) This sterilization was performed less than 30 days but more than 72 hours after the date of the individual's signature on this consent form because of the following circumstances …

CONSENT FOR STERILIZATION - HHS.gov

    https://opa.hhs.gov/sites/default/files/2022-07/consent-for-sterilization-english-2025.pdf
    sign this consent form, may result in an inability to receive sterilization procedures funded through federally assisted public health programs. All information as to personal facts and …

Updated Sterilization Consent Form (IB 22-27) | Louisiana …

    https://www.louisianahealthconnect.com/newsroom/updated-sterilization-consent-form--ib-22-27-.html
    Updated Sterilization Consent Form (IB 22-27) Date: 08/18/22. Louisiana Healthcare Connections would like to let providers know of a revised and published …

Louisiana Department of Health Informational …

    https://ldh.la.gov/assets/docs/BayouHealth/Informational_Bulletins/2022/IB22-9.pdf
    Sterilization Consent Form Louisiana Medicaid has been in communication with the Office of Population Affairs (OPA) concerning the upcoming expiration date of April 30, 2022, on …

Manuals, Forms and Resources | Louisiana Healthcare …

    https://www.louisianahealthconnect.com/providers/resources/forms-resources.html
    Personal Appeal Representative Form (PDF) Abortion Consent Form (PDF) LDH Consent for Hysterectomy Form (PDF) Consent for Sterilization Form (PDF) Consent for …

Sterilization Policy, Professional & Facility, Louisiana

    https://ldh.la.gov/assets/medicaid/MCPP/2.11.22/1171_UHC_Sterilization_Policy.pdf
    Exception: with the permission of the Louisiana Department of Health (LDH), UnitedHealthcare allows hospitals and ancillary providers to submit sterilization claims …

Medicaid | Department of Health | State of Louisiana

    https://www.lamedicaid.com/provweb1/Forms/forms.htm
    Mailing: Louisiana Department of Health | P.O. Box 629 | Baton Rouge, LA 70821-0629 Physical: 628 N. 4th Street | Baton Rouge, LA 70802 | Phone: 225.342.9500 | Fax: …

Medicaid | Department of Health | State of Louisiana

    https://www.lamedicaid.com/providerupdate/provider_update0691.htm
    When billing for an epidural given at the time of delivery, one's claim for CPT-4 code 62279 must be accompanied by a consent form if a sterilization was performed …



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