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Click ‘Get Form’ to open the DHS 1149 instructions form in the editor.
Begin by entering the physician's details in the designated fields, ensuring accuracy as this information is crucial for certification.
In the section regarding the medical emergency, provide a clear diagnosis and explain the consequences of not receiving immediate treatment. This will help substantiate the need for expedited processing.
List all necessary treatments, medications, and medical supplies that are required immediately and cannot be obtained without insurance coverage.
The physician must sign and date the form to validate it. Ensure that all signatures are legible.
Once completed, submit the form electronically through our platform to ensure it reaches the DHS Eligibility Branch promptly.

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