Medicaid


Medicaid

  

Related Forms:

MC-1

Consent for Treatment, Release of Information and Medicaid Reimbursement

MC-1SP Medicaid Consent  (Spanish)

 

MC-5 

Psychological Services Log for Medicaid

  MC-5L Referral for School- Based Psychological Testing & Evaluation 

 

MC-13

Medicaid Speech-Language Referral

 

MC-14

Medicaid Supplemental Signature Page

  MC-15  Occupational Therapy Referral
  MC-16 Physical Therapy Evaluation/Treatment Referral 
     
Horry County Schools

335 Four Mile Rd. | PO Box 260005 | Conway, SC 29528

Phone 843-488-6700

Horry County Schools does not discriminate on the basis of race, religion, color, national origin, sex, disability, age, immigrant status, English-speaking status, or any other characteristic protected by applicable federal or S.C. law in its programs or activities. For questions regarding the nondiscrimination policies call 843-488-6700, or write Horry County Schools, 335 Four Mile Rd., Conway, SC 29526 or click here for a list of contacts.

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