State of hi med quest application 2025

1. Click ‘Get Form’ to open the state of hi med quest application in the editor.
2. Begin by entering the patient’s name in the designated field. Ensure you print or type clearly for legibility.
3. Fill in the birthdate using the format Month/Day/Year, and select the appropriate sex option.
4. Indicate Medicare eligibility by checking 'Yes' or 'No' for Parts A and B, and provide the ID number if applicable.
5. Complete the present address section, selecting from options like Home, Hospital, or Care Home as appropriate.
6. Provide details about the attending physician or primary care provider, including their contact information.
7. In the referral information section, ensure all required fields are filled out accurately to avoid delays.
8. Review all sections for completeness before submitting. Use our platform's features to save your progress as needed.

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