Health Care Form Templates

This form is used for conducting health care appraisals in the state of Michigan. It includes information about the medical facility and its services, as well as an assessment of the quality of care provided.

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

This form is used for the In-Home Supportive Services Program in California. It is specifically for notifying provisional approval of health care certification exceptions granted under the program.

This Form is used for In-home Supportive Services (IHSS) program applicants in California. It serves as a notice to inform applicants about the Health Care Certification requirement.

This document is for Maryland residents and helps them make decisions about their health care. It is a worksheet that guides individuals through the process of determining their preferences for medical treatment and end-of-life care.

This form is used for requesting the withdrawal of HCBS (Home and Community Based Services) certification in Arizona.

This form is used for requesting a leave of absence from work while using funds from a Health Care Flexible Spending Account in Delaware.

This document is used for submitting claims for Flexible Spending Account expenses in the state of Maryland.

This document is for enrolling in a Flexible Spending Account (FSA) in Ohio. FSAs allow you to set aside pre-tax money for certain healthcare or dependent care expenses.

This document outlines the plan for providing assisted living services in Alaska. It includes details on the services offered, facilities, and care provided to residents.

This document is used for expressing your healthcare wishes in Alaska. It allows you to designate a healthcare power of attorney and specify your healthcare preferences in case you are unable to make decisions for yourself.

This form is used for submitting health insurance claims. It is commonly used by individuals to request reimbursement for medical expenses.

This document is a Spanish form used to apply for SNAP benefits, healthcare assistance, and Tea/RCA in Arkansas.

This form is used for applying for SNAP (Supplemental Nutrition Assistance Program), health care benefits, and Tea/RCA (Transitional Employment Assistance/Responsible Choice Act) benefits in Arkansas.

This Form is used for applying for Snap, Health Care, and Tea-Rca benefits in Arkansas for Marshallese individuals.

This form is used for requesting reimbursement for medical expenses incurred in British Columbia, Canada.

This Form is used for granting power of attorney for health care decisions in Nebraska.

This document is a notice informing individuals in South Carolina about an extension of their COBRA continuation coverage. COBRA allows people to maintain their health insurance coverage after certain qualifying events, such as job loss or reduction in work hours.

This form is used for renewing Minnesota Health Care Programs in Minnesota.

Individuals may use a letter such as this as a reference when they would like to request a copy of their records from a medical organization where they have been treated.