Device Trials / Funding

Posted on by Maureen Nevers

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.

Medicaid SGD Evaluation Form

by Department of Vermont Health Access

Required evaluation form for requesting Speech Generating Device to be funded by Vermont Medicaid.

Evaluation Form

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.

CMN Form

Application Process Resources

Data Charts