Ohio Department of 0HGLFDLG ABORTION CERTIFICATION FORM ...: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by selecting the appropriate reason for the abortion from the options provided. Check only one box that best describes the situation.
Fill in the Patient’s Name in the designated field, ensuring accuracy for proper identification.
Enter the Patient’s Address, including City, State, and Zip Code to ensure correct documentation.
Provide the Patient’s Medicaid Billing Number in the specified section for reimbursement purposes.
Next, type in the Physician’s Name and their Medicaid/NPI Provider Number to validate medical authority.
The Physician must sign and date the form at the bottom to complete it. Ensure all fields are filled out correctly before submission.

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What are the 5 types of abortion miscarriage?

Classification of Abortion TypeDefinition Early Abortion before 12 weeks gestation Late Abortion between 12 and 20 weeks gestation Spontaneous Pregnancy loss at 20 weeks gestation Threatened Vaginal bleeding occurring before 20 weeks gestation without cervical dilation8 more rows

Is a miscarriage documented as an abortion?

Miscarriage is a naturally occurring event, unlike medicine abortions or abortion procedures. A miscarriage may also be called a spontaneous abortion. Other terms for the early loss of pregnancy include: Complete abortion: All of the products (tissue) of conception leave the body.

What is an abortion certificate?

I, (physicians name), docHub that on the basis of my professional judgment, an abortion procedure is necessary because (clients full name, Medicaid number, and complete address) suffers from a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the

What are the criteria to get an abortion?

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or.

What counts as an abortion?

An abortion (also known as a termination) is the medical process of ending a pregnancy. An abortion is different from a miscarriage, which is the loss of your baby before 24 weeks, without medical intervention.