Ohio medicaid abortion 2026

1. Click ‘Get Form’ to open the Ohio Medicaid Abortion Certification Form in the editor.
2. Begin by selecting the appropriate reason for the abortion from the first section. Carefully read each option and check only one box that applies to the patient's situation.
3. Fill in the Patient’s Name in the designated field, ensuring accuracy for identification purposes.
4. Enter the Patient’s Address, including City, State, and Zip Code, to provide complete contact information.
5. Input the Patient’s Medicaid Billing Number in the specified field to facilitate billing processes.
6. Next, type in the Physician’s Name and their Medicaid/NPI Provider Number to authenticate the medical professional involved.
7. The Physician must then sign in the designated area and include the Date of signing to validate this certification form.

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