Dhs 1139a form: Fill out & sign online

Here's how it works

01. Edit your dhs 1139a form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send dhs 1139a via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out hawaii dhs 1139a online with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the hawaii dhs 1139a in the editor.
Begin by entering your full name in the designated fields for First, Middle, and Last names.
Fill in your Business Address, including Number, Street, Suite (if applicable), City, State/Country, and Zip Code.
Provide your Place of Birth and Telephone Number. Ensure that all information is accurate.
Indicate your residency status in Hawaii by selecting 'Yes' or 'No' and specify how long you have been a resident if applicable.
Answer questions regarding your certification or licensing status in other states. If applicable, list those states.
Complete the Education section by listing institutions attended, major courses of study, graduation dates, and degrees conferred.
In the Experience section, detail your employment history including positions held and duties performed.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

Start filling out your hawaii dhs 1139a online for free today using our platform!

See more hawaii dhs 1139a online versions

We've got more versions of the hawaii dhs 1139a online form. Select the right hawaii dhs 1139a online version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (61 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What is Hoku in Hawaii?

HOKU, in Hawaiian, means guiding star. Kahu, in Hawaiian, means caretaker or pastor or one who looks after their flock.

Does Hawaii have free health insurance?

Medicaid provides free or low-cost health coverage to low-income individuals and their families. In Hawaii, Medicaid is called QUEST Integration. QUEST Integration is managed by Hawaiis Department of Human Services Med-QUEST Division.

What is the income limit to qualify for Medicaid in Hawaii?

Income Asset Limits for Eligibility Feb. 2025 Jan. 2026 Hawaii Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingleMarried (both spouses applying) Income Limit Asset Limit Institutional / Nursing Home Medicaid No hard limit* $3,000 Home and Community Based Services $1,499.17 / month $3,0001 more row Jan 20, 2025

How to get Quest Medical in Hawaii?

Apply for Medicaid Call Med-QUEST Customer Service: 1-800-316-8005 toll-free TTY users, call 1-855-889-4325 toll-free or 711. Fillable PDF Application. Fill out the application as completely as possible. Print the completed application then mail or fax to the Med-QUEST Division Eligibility Office nearest you.

dhs1139a

Hawaii dhs 1139a online login Hawaii dhs 1139a online renewal Hawaii dhs 1139a online form Hawaii dhs 1139a online application Hawaii Medicaid Provider portal DHS 1139 form Hawai'i Medicaid Provider Manual Hawaii Medicaid Provider Enrollment