Nevada Department of Health and Human Services Forms

This form is used for requesting prior authorization for oxygen equipment and supplies in Nevada.

This Form is used for requesting prior authorization for long-term acute care in Nevada.

This form is used for requesting authorization for outpatient or rehabilitative behavioral health services in Nevada.

This Form is used for requesting authorization for self-directed skilled services in Nevada. It provides instructions for completing the Form FA-24C.

This form is used for conducting pre-admission screening and resident review in Nevada to identify individuals who need Pasrr Level 1 Identification Screening.

This form is used for requesting prior authorization for the medication Tedizolid (Sivextro) in the state of Nevada.

This document is a checklist for renewing state certification in Nevada. It provides the necessary steps and requirements for completing the renewal process.

This Form is used for submitting percolation test data for individual sewage disposal systems in Nevada.

This document gives authorization for the release of a patient's medical information in Nevada.

This document is a formal request to schedule a hearing in the state of Nevada. It is used when someone wants to present their case or argument in front of a judge or administrative hearing officer.

This document outlines the terms and conditions for a mentoring agreement in the state of Nevada. It provides clear guidelines and expectations for both the mentor and mentee.

This form is used for requesting prior authorization for inpatient medical/surgical services in Nevada.

This Form is used for correcting data related to the Pasrr/Loc program in the state of Nevada.

This Form is used for Personal Care Services recipients in Nevada who want to request a transfer of their provider.

This form is used for requesting prior authorization for pulmonary arterial hypertension agents in Nevada.

This Form is used for requesting prior authorization for Xyosted in the state of Nevada.

This Form is used for reporting the incidence of cancer cases in Nevada.

This document is used by physicians in Nevada to provide professional statements or opinions related to a patient's medical condition or treatment.

This document is used for verifying the authenticity and details of a police report in the state of Nevada. It ensures that the information in the report is accurate and can be relied upon for legal purposes.

This document is used for verifying a police report related to a DUI incident in the state of Nevada.

This type of document is a "Request for Hearing" in the state of Nevada. It is written in Spanish.

This Form is used for requesting pre-authorization for payment in the state of Nevada.

This document allows an employer in Nevada to release wage loss information upon authorization from the employee.

This document is used to certify a disability related to a crime in the state of Nevada. It provides medical documentation and support for individuals who have been affected by a crime and need to prove their disability.