MD or Nurse Practitioner signature is required.
Physician Assistant: MD signature may be delegated to a Physician Assistant. In this case, a supervising physician must be identified.
ICF/IID: requires active treatment of developmental disability under supervision of a qualified intellectual / developmental disability professional.
Community services: are Home/Community Based Services adequate to meet the needs of this applicant?
Mental status: check Yes or No. If Yes, indicate frequency: 1 = seldom; 2 = frequent; 3 = always.
| Question | Answer |
|---|---|
| Form Name | OIDD Form 90-L |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 151 |
| Avg. time to fill out | 26 min |
| Edition | Revised 7/1/2026 |
| Who signs | The applicant or responsible party, and the MD or Nurse Practitioner (the MD signature may be delegated to a Physician Assistant, with a supervising physician identified) |
| Other names | 90-L, 90L, 90 L, OIDD Form 90-L, Form 90-L, Request for Medical Eligibility Determination |
| Official source | OIDD Form 90-L (Rev 7/1/2026), Louisiana Department of Health |
Form 90-L isn’t the one you’re looking for?