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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 4. Department of State Health Services (DSHS) Family Planning Program Services : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.8 Sterilization and Sterilization-Related Procedures

Per federal regulation 42 CFR 50, Subpart B, all sterilization procedures require an approved Sterilization Consent Form.
Refer to:
Form GN.3, “Sterilization Consent Form (Spanish)” in this handbook.
Form GN.1, “Sterilization Consent Form Instructions (2 pages)” in this handbook.

Texas Medicaid & Healthcare Partnership
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