Health Care Form Templates

This form is used for attesting compliance with health care services in the state of Ohio. It ensures that health care providers are meeting the necessary standards and regulations.

This form is used for collecting health insurance information in the state of California.

This document is for the signature page of a Health Care Clinic Establishment application in the state of Florida.

This document is used for conducting a survey to establish a health care clinic in Florida.

This Form is used for applying for Radiologic Technology Certification in the state of Florida.

This document is used for designating someone to make healthcare decisions on your behalf in Jackson County, Illinois.

This document allows a person to appoint someone else to make financial and legal decisions on their behalf in the state of Montana.

This document grants someone the authority to make legal and financial decisions on your behalf in New Jersey.

This type of document, called the Durable Power of Attorney Form, is used in the state of North Carolina. It allows someone to appoint another person to make important decisions on their behalf, even if they become incapacitated.

This document is used to grant someone the authority to make financial and legal decisions on your behalf in Rhode Island.

By using this type of form in the state of Alabama, a person may choose a representative to legally represent them in a medical setting.

This type of form gives permission for an agent to represent a principal in a medical setting, allowing them to make specific choices relating to treatment and any other significant medical decisions in the state of Hawaii.

This is a document used in Michigan that legally allows a person to select and use an agent relating to medical decisions.

This form is used in New Hampshire to allow another individual (usually a close friend or relative) the power to make important medical choices on behalf of the principal.

This type of form is used in New York and will give an agent the power to make important choices concerning treatment plans on behalf of the principal.

This form is used in Texas when a principal wants to have a second option concerning their medical treatment and have another individual that would be able to make specific decisions in regards to their treatment.

This type of form is needed in Oregon in cases when a principal wants to delegate themselves an agent, giving them legal permission to make vital financial decisions on their behalf.

This form provides a privacy act statement for health care records.

This document is used for applying for an initial residential health care institution license in the state of Arizona. It is required for healthcare providers who wish to operate a residential facility for the care of individuals in need of medical services.

This document is an Asthma Action Plan specific to the Washington, D.C. area. It provides guidance on managing asthma symptoms and emergencies in the region.

This form is used for requesting non-emergent medical transportation for completing an administrative medical examination in Oregon.

This Form is used for assessing the multidisciplinary team and person-centered care planning process in California.

This form is used for obtaining prior authorization and submitting a substance abuse attachment in the state of Wisconsin.

This Form is used for obtaining prior authorization and preferred drug list for Non-steroidal anti-inflammatory drugs (NSAIDs) in Wisconsin.

This document is used to request a determination of coverage for an insurance claim or benefit. It typically involves submitting information and evidence to support the request and may be required by the insurance company before they make a decision on coverage.

This document is used for attesting the architecture of health care institution license applications in the state of Arizona. It outlines the necessary requirements and guidelines for ensuring the proper design and structure of these applications.

This form is used for members to submit complaints and appeals in the state of Alaska.

This form is used for the Masshealth Long-Term-Care Eligibility Review in Massachusetts. It is used to determine if individuals are eligible for long-term care services.

This document certifies that a health care provider has confirmed an employee's serious health condition under the Family and Medical Leave Act in Delaware.

This document is a certification for a health care provider, in Delaware, stating that a family member has a serious health condition and is eligible for leave under the Family and Medical Leave Act.