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Pm 284 sterilization consent form

Pm330 2025

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The document is a consent form for sterilization issued by the State of California's Health and Human Services Agency. It outlines the individual's right to make an informed decision regarding sterilization, emphasizing that their choice will not affect their eligibility for federally funded benefits. The form includes statements from both the individual seeking sterilization and the physician, confirming understanding of the procedure's permanence, risks, and alternatives. It also stipulates that consent can be withdrawn at any time without loss of benefits.

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Does Medi-Cal cover tubal ligation?

Medi-Cal covers sterilization services for people 21 years of age and older, including vasectomies and tubal ligation. To avoid coercion, there are a number of informed consent procedures individuals must undergo before any sterilization procedure can be performed.

What is a PM330 form?

PM 330. 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. g CONSENT TO STERILIZATION g. I have asked for and received information about sterilization from.

At what age can I get my tubes tied in California?

Coverage Conditions The individual is at least 21 years old at the time written consent for sterilization is obtained. Note: Under Medi-Cal regulations, a patient must be 21 years old to give consent to a sterilization.

Is tubal ligation covered by Medi-Cal?

Tubal Ligations A tubal ligation performed during the same hospitalization as a vaginal delivery (CPT code 58605), or at the time of a cesarean section or intra-abdominal surgery (CPT code 58611), is covered by Medi-Cal as a separately reimbursable service.

Where can I get sterilized?

You can get a tubal ligation at a doctors office, hospital, or health clinic. Many Planned Parenthood health centers also do some types of sterilization procedures.

pm330 consent form

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How do you qualify for tubal ligation?

There is no legal age requirement for getting your tubes tied in the United States. There may, however, be restrictions on who will pay for the procedure, especially if youre on Medicaid or have health insurance through another federally funded program. There are also variations about consent in state law.

How much is tubal ligation out of pocket?

How much does tubal ligation cost? Tubal ligation can cost between $0 to $6,000, including follow-up visits. The cost of a tubal ligation varies and depends on where you get it, what kind you get, and whether or not you have health insurance that will cover some or all of the cost.