Missouri Residents

Note: Please print this page so you have the instructions available while filling out the forms.

OIG/HHS Medicare/ Medicaid Excluded list:

The form you need to complete for the Medicare/Medicaid excluded list is found on the Federal Government web site http://exclusions.oig.hhs.gov

Directions to complete the form

• On the web page referred to above, type your name(s) in the spaces provided.
• Include any names used in the past seven years
• Click the Search button and print the results
• Turn in the printed results to your program chair

State Criminal Background and Abuse Check:

The form you need to complete to request both the background and abuse check is found on the Missouri State web site at http://www.dhss.mo.gov/FCSR/AppsForms.html

1. Print the Worker Registration form.
2. Under Section A, check the box for 'Voluntary Registrant'.
3. Instructions for completing the rest of the form are included when you print it out. 
4. Bring the result form in to the program chair.
5. Turn the original search result in to the program chair.