VT Medicaid Forms
![Form with multiple fields of questions and blank space or check boxfor answers. State of Vermont emblem and contact information at the top.](https://cdci.w3.uvm.edu/blog/aslresources/wp-content/uploads/sites/5/2023/11/image-8.png)
Medicaid SGD Evaluation Form
by Department of Vermont Health Access
Required evaluation form for requesting Speech Generating Device to be funded by Vermont Medicaid.
![](https://cdci.w3.uvm.edu/blog/aslresources/wp-content/uploads/sites/5/2023/04/Screenshot-2024-09-01-at-6.31.41 PM-873x1024.png)
VT Medicaid Medical Necessity Form
by Department of Vermont Health Access
When requesting a speech device from VT Medicaid, the applicant’s Primary Care Physician must complete this form of medical necessity.