Hawaii med quest online application form for medical assitant 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Screen Date' in MMDDYY format, followed by the patient's name (Last, First, Middle Initial) and Medicaid/QUEST ID.
3. Fill in the 'Birthdate' and select the patient's sex by marking either M or F.
4. In the 'Immunizations Given Today and Status' section, check off each immunization that was administered during the visit.
5. Document any screenings done today under 'Screening Done Today', indicating results for vision and hearing screenings as applicable.
6. If referrals were made today, list them in the designated area. If none are needed, leave this section blank.
7. Complete the 'Care Coordination Assistance Needed' section by providing relevant phone numbers if assistance is required.
8. Finally, print your name and provide your signature at the bottom of the form to finalize it.

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