Sterilization Consent Form

HCA Apple Health

Effective for claims with dates of service on and after January 1, 2016, the Health Care Authority (agency) requires providers to use the federal consent form HHS-687 for sterilization procedures. The agency will accept HCA 13-364 forms that have already been completed through July 15, 2016. See the agency’s Sterilization Supplemental Provider Guide for more details.