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Georgia DMA-6A: Physician Recommendation, Pediatric

Georgia Medicaid uses the DMA-6A, Physician's Recommendation for Pediatric Care, to establish that a child needs hospital, nursing facility or ICF level of care. It is used for the Nursing Facility, GAPP and TEFRA/Katie Beckett programs. The physician reports history, diagnoses, medications and treatment plan and certifies the level of care, and a state contractor records its own determination at the bottom.

Who completes it

The parent or legal representative completes Section A and signs the records release. The physician completes Section B and signs the level-of-care certification; Section C, the nursing care evaluation, is signed by an MD or RN.

Submitting and payment

How to submit it
The completed form accompanies the child's Medicaid application for the selected program, and Georgia's review contractor completes the section marked "Do not write below this line."
Who pays
The form sets no fee for the physician; it supports the child's Medicaid eligibility for the selected program.

Good to know

  • Mark the program at the top: Nursing Facility, GAPP or TEFRA/Katie Beckett. The physician also marks the type of recommendation: initial, change in level of care or continued placement.
  • Section B asks whether the child's condition could be managed with community care or home health services and whether the child is free of communicable diseases.
  • Section C checks nursing needs such as tube feeding, oxygen, ventilator, trach care, suctioning, seizures and therapy visit frequency.
  • The parent's release of records to DCH and DHS expires twelve months after signing. The current version is DMA-6A (11/2011).

Get the official form

Download the current version from the source each time; forms change without notice.

Physician Recommendation for Pediatric Care

Official pagePDF

Fill it with Vero

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What level of care does the Georgia DMA-6A certify?

The physician recommends hospital, nursing facility or IC/MR facility level of care and signs a statement that the patient requires that level of care. The physician also gives the length of time care is needed and whether the child's condition could be managed through community care or home health services.

Is the DMA-6A used for Katie Beckett in Georgia?

Yes. The form's program checkboxes are Nursing Facility, GAPP and TEFRA/Katie Beckett, so it serves as the physician's level-of-care recommendation for a child applying under the TEFRA/Katie Beckett category as well as for pediatric nursing facility and GAPP cases.

Who completes Section C of the DMA-6A?

Section C, the evaluation of nursing care needed, is signed by an MD or RN. It uses checkboxes for nutrition, bowel, cardiopulmonary status, mobility, behavior, skin, urogenital needs, surgeries, therapy visits and neurological status, plus a pre-admission certification number.