A Medicaid application must be completed by the patient and his/her primary care physician in order to participate. Applicant?s health care provider must complete the Statewide Medical Assistance Provider Certification form in its entirety. Your health care provider must clearly state your diagnosis, and indicate how your medical diagnosis prevents you from utilizing accessible public transportation. Any stated disability or diagnosis provided by your treating physician must be legible and understood by non-medical personnel. Abbreviations, ICD or DSM codes are not accepted. The Provider Certification form must be signed by your health care provider, certifying under oath that the services are medically necessary. The medicaid application may be obtained from the Medicaid office located at 101 Monroe Street, 5th Floor, Rockville, MD between the hours of 8:00 AM - 4:30 PM. or from the website referenced below. For additional information, please call 240.777.5890.