Sterilization Consent Form

Friday, February 1, 2019

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.

Author: 
GDIT, (800) 688-6696