WebMay 14, 2024 · The Office of Population Affairs (OPA) has updated and published a new Sterilization Consent form (HHS 687), with an expiration date of 4/30/2024. This new form is effective immediately. Any previous forms must have had a valid expiration date at the time of signature in order to be accepted by DXC Technology. WebForm Approved: OMB No. 0937-0166 Expiration date: 10/31/2015 NOTICE: YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS.
CONSENT FOR STERILIZATION
WebApr 5, 2024 · HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business. Search for Forms ES = Spanish version available. Search forms Pagination … Filter by Series 0 - 999 (38) 1000 - 1999 (426) 2000 - 2999 (203) WebConsent for Sterilization: Form HHS-687 Author: U.S. Department of Health & Human Services Subject: This form allows an individual to provide consent for sterilization. … thunder bread recipe
Medicaid Department of Health State of Louisiana
WebMay 25, 2024 · Effective June 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) Form 1723: Consent for Sterilization will be replaced with Form … WebThis form allows an individual to provide consent for sterilization. Statements are also included for an interpreter, a person obtaining consent, and a physician. The form begins with a cover page describing the purpose of the form and its expiration date. The form is available in English, in Spanish, and in large-print versions. WebBehavioral Health Forms. Clinical Authorization Forms. COVID Vaccine Form. Early and Periodic Screening, Diagnosis and Treatment Exam Forms. Electronic Funds Transfer (EFT) Forms. Forms to Join Our Networks. Lead Risk Assessment Form. OBAT Attestation for Nonparticipating Providers. Other Forms. thunder breaker keyboard layout maplestory