Health Care Form Templates

This document is used for healthcare providers in Florida to apply for certification. It is called DFS Form 3160-0020 Health Care Provider Application for Certification.

This Form is used for reporting and documenting critical incidents involving HCBS providers in Colorado.

This form is used for reporting on-site health care provided by non-health care staff in Florida's DJJ facilities.

This Form is used for applying for health insurance coverage in California and obtaining an order for it.

This form is used for ordering reimbursement of health care expenses in Alaska.

This Form is used for recording immunization records in the state of Delaware.

This Form is used for coordinating insurance benefits for individuals in Delaware.

This form is used for enrolling in health benefits in the state of Delaware.

This document outlines the health benefits available to operations employees in Florida. It provides information about the different insurance plans, coverage options, and other wellness programs provided by the employer.

This document provides a summary of health benefits available to residents in California, including information about coverage, costs, and important plan details.

This document describes the circumstances under which someone in California may be ineligible for Medicare certification.

This document is for a Do-Not-Resuscitate (DNR) order that applies outside of a hospital setting in the state of Missouri. It allows individuals to make their wishes known regarding resuscitation efforts if they experience cardiac arrest or stop breathing outside of a hospital.

This document grants someone the authority to make health care decisions on your behalf in the state of Illinois.

This form is used for applying for self-insurance authorization in the state of Hawaii.

This form is used for reviewing applications for prepaid health care plans in Hawaii. It is for individuals who are applying for or already enrolled in a prepaid health care plan and need to submit their application for review.

This Form is used for appointing a trusted person to make healthcare decisions on your behalf in the state of Illinois.

This form is used for certifying that an individual has received information and education about health care options in the state of Illinois.

This form is used for healthcare providers in Illinois to enter into an agreement to participate in the Illinois Medical Assistance Program.

This form is used for health care providers in Kansas to certify their eligibility for certain benefits or services.

This form is used for parents in Kansas to give consent for medical care for their child.

This Form is used for filing the Kentucky Health Care Provider Tax Return in Kentucky.

This form is used for certifying health care providers in the state of Georgia. It verifies that the provider meets certain qualifications and is authorized to provide healthcare services in the state.

This form is used for health care workers in Illinois to apply for a waiver.

This form is used for giving consent to medical care in the state of Kansas. It allows individuals to authorize medical providers to administer necessary care and treatment.

This Form is used for applying to the Summer Health Care Internship Program in Minnesota. It is for individuals interested in a healthcare internship opportunity during the summer months.

This form is used for applying for health coverage and financial assistance to help cover the costs of healthcare in Minnesota. It is available in Vietnamese language for Vietnamese-speaking residents.

This document provides information about the cost participation for families in Missouri. It explains the expenses that families may need to contribute towards and how to navigate the process.

This Form is used for creating a specialized health care plan for individuals with special needs in the state of Montana. It helps to ensure that they receive the necessary medical care and support.

This form is used for applying for a vehicle exemption for certain health care professionals in Montana.

This form is used for notifying workers in New York about their right to choose a healthcare provider authorized by the Workers' Compensation Board. It is available in English and Chinese.