Author: GDIT, (800) 688-6696
The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated.
https://www.hhs.gov/opa/sites/default/files/consent-for-sterilization-english-updated.pdf (English)
https://www.hhs.gov/opa/sites/default/files/consent-for-sterilization-spanish-updated.pdf (Spanish)
These links can also be accessed from the NC Medicaid website: https://medicaid.ncdhhs.gov/forms.
Providers can access the Sterilization Consent Form by clicking on the words “Sterilization Consent Form.” Providers may choose to complete the form for each individual or pre-populate information on the site prior to printing the consent form. Signature fields may not be pre-populated.
Providers should always use the latest version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
Providers with questions can contact the GDIT Call Center at 1-800-688-6696 or NCTracksprovider@nctracks.com.