Nevada Department of Health and Human Services Forms

This Form is used for certifying that an abortion is necessary to save the life of the mother in the state of Nevada.

This form is used for requesting prior authorization for the use of third generation cephalosporins and fluoroquinolone medications in Nevada.

This form is used for requesting prior authorization for Epidiolex (Cannabidiol) medication in Nevada.

This form is used for requesting prior authorization for compounded medication in Nevada.

This Form is used for requesting prior authorization for prescribing opioids to individuals under the age of 18 in Nevada.

This form is used for requesting prior authorization for a specific quantity limit of a short-acting bronchodilator medication in Nevada.

This form is used for requesting prior authorization for oral oncology agents in the state of Nevada.

This form is used for requesting prior authorization for immunomodulator drugs in the state of Nevada.

This form is used for requesting prior authorization for the medication Linezolid (brand name Zyvox) in the state of Nevada.

This form is used for notifying the Nevada Medicaid Hospice Program about the election for pediatric hospice care.

This document is an addendum for providers participating in the Nevada Medicaid Hospital Presumptive Eligibility program. It contains additional information and requirements for providers seeking to participate in the program.

This Form is used for requesting Trogarzo treatment in Nevada.

This document is used for requesting patient treatment with Egrifta Tesamoralin in Nevada.

This form is used to collect demographic information about a facility in Nevada. It helps in understanding the population and characteristics of the facility's location.

This form is used for reporting cancer incidence in the state of Nevada. It provides instructions on how to accurately report cancer cases, including the required information and submission process.

This form is used for Nevada residents to sign up for a Web Plus user account.

This document is used for requesting a provisional license to become an ambulance attendant in the state of Nevada.

This document is for the Skills Review in the state of Nevada. It is used to assess and evaluate an individual's skills and qualifications for a specific job or occupation in Nevada.

This form is used for applying for a Radiation Control Program License in the state of Nevada. It is required for individuals or organizations that wish to use or possess radioactive materials in the state.

This form is used for attesting to the license, limited license, or rural authorization in Nevada as required under Sb130 SEC.75.

This form is used to apply for a certified copy of a death certificate or verification in the state of Nevada. The form is necessary to obtain official proof of a person's death.

This form is used for rental applicants in Nevada to verify their rental history.

This form is used for the completed application checklist for the Intake Site in Nevada.

This Form is used for an EMS Addendum in Nevada.

This Form is used for requesting benefit verification in Nevada.

This document is an addendum form used in Nevada for reporting business activity.

This form is used for verifying cash contributions in Nevada.

This Form is used for submitting issue resolutions related to Nevada tax matters.

This type of document is a Form 2993-EGS used for applying for public assistance in Nevada.

This document is used for providing direct deposit information and authorizing the Division of Welfare and Supportive Services in Nevada to deposit funds into your account.

This Form is used for applying for financial assistance in the state of Nevada.