Statutes, codes, and regulations
Indiana Administrative Code
Title 470 - DIVISION OF FAMILY RESOURCESArticle 12 - PRIOR REVIEW OF OFF-SITE MEDICAL SERVICES; DEPARTMENT OF CORRECTION, STATE BOARD OF HEALTH, AND DEPARTMENT OF MENTAL HEALTH
Rule 470 IAC 12-1 - Prior Review and Authorization of Requests for Off-Site Medical Services
Section 470 IAC 12-1-3 - Request forms

470 Ind. Admin. Code 12-1-3

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Current through December 12, 2024
Section 470 IAC 12-1-3 - Request forms

Authority: IC 12-13-2-3; IC 12-13-5-3; IC 12-16-1-3

Affected: IC 12-16-1

Sec. 3.

(a) Requests for medical services must be made on forms specified by the department, using procedures developed by the department.
(b) Request forms shall contain such information as the department deems necessary to implement the provisions of IC 12-5-7[IC 12-5 was repealed by P.L. 2-1992, SECTION 897, effective February 14, 1992.].
(c) The department is not required to review any request form which is not properly signed and co-signed, and which has not been completed in its entirety. Request forms shall be returned without action if they are incomplete, illegible, or if they bear rubber-stamp; facsimile; machine-drawn, or any other substitute signature.

470 IAC 12-1-3

Division of Family Resources; 470 IAC 12-1-3; filed Oct 26, 1983, 10:22 am: 7 IR 43; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA
Readopted filed 11/13/2019, 11:56 a.m.: 20191211-IR-470190490RFA