If you do not tell us the dates of service, when we receive this form (470-4299) we will assume the emergency began the first of the month of application and ends the last day of the following month.
Organ transplant: please specify if treatment was related to an organ transplant procedure furnished on or after August 10, 1993.
Labor and delivery: were services for labor and delivery of a child?
Release: this release expires one year from the date of signature.
Copy: a photocopy of this signed authorization shall have the same force and effect as the original.
| Question | Answer |
|---|---|
| Form Name | Form 470-4299 |
| Form Length | 1 page |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Edition | Rev. 9/15 |
| Issuing agency | Iowa Department of Human Services |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | 470-4299, 470 4299, Form 470-4299, Verification of Emergency Health Care Services |
| Official source | Form 470-4299 (Rev 9/15), Iowa Department of Human Services |
Iowa Form 470 4299 isn’t the one you’re looking for?