Department of Vermont Health Access Forms
The Department of Vermont Health Access is responsible for managing and administering healthcare programs in the state of Vermont. Their main purpose is to ensure that residents of Vermont have access to affordable healthcare services through various programs such as Medicaid and other state-funded healthcare initiatives. They provide assistance with enrollment, eligibility determination, and coordination of healthcare benefits for eligible individuals and families in Vermont.
Documents:
99
This Form is used for applying for health coverage and financial assistance in the state of Vermont.
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Word
This Form is used to apply for health coverage in the state of Vermont. It is specifically for residents who need to apply for insurance benefits.
This document is used to report and assess ambulance agencies in the state of Vermont. It helps ensure the quality and efficacy of emergency medical services provided by these agencies.
This Form is used for making new requests in the state of Vermont.
This document is a waiver of liability form specifically for personal choice drivers in the state of Vermont. It allows drivers to release liability for any accidents or damages that may occur while operating their vehicles.
This document is a transportation needs assessment tool specifically designed for the state of Vermont. It helps analyze and evaluate the transportation requirements of the state to aid in planning and decision-making processes.
This form is used for notifying Medicaid in Vermont about the admission of a child or adolescent to an inpatient facility. It helps ensure that Medicaid is aware of the admission and can appropriately process the necessary claims and payments. This document is important for managing the healthcare needs of children and adolescents covered by Vermont Medicaid.
This form is used for requesting prior authorization for the Vermont Medicaid Eyeglass Program in Vermont.
This form is used for requesting prior authorization for a urine drug test in the state of Vermont. It helps ensure that the test will be covered by insurance.
This form is used for abortion certification in the state of Vermont.
This form is used for requesting a homestead exemption in the state of Vermont.
This form is used for applying for a Homestead Exemption in Vermont if your household income is below 300 percent of the Federal Poverty Level.
This form is used for certifying abortions in the state of Vermont.
This form is used for requesting prior authorization for Humira (Pediatric) for patients who are 18 years old or younger in the state of Vermont.
This form is used for requesting prior authorization for the medication Kineret in the state of Vermont.
This Form is used for requesting prior authorization for opioid medications in Vermont. It ensures the safe use of morphine milligram equivalent (MME) for patients.
This form is used for submitting a prior authorization request for oral oncology treatment in the state of Vermont.
This form is used for requesting prior authorization for Vivitrol medication in the state of Vermont.
This document is an exception to the required 90-day maintenance medication fill in the state of Vermont.
This document is a Cimzia Prior Authorization Form specific to the state of Vermont. It is a required form to obtain prior authorization for Cimzia medication.
This document is used for requesting prior authorization for dental services in the state of Vermont.
This Form is used for requesting prior authorization for limited orthodontic treatment in the state of Vermont.
This Form is used for requesting prior authorization for treatment to control harmful habits in the state of Vermont.
This document is a form used in Vermont for individuals under the age of 21 or pregnant women to request prior authorization for denture services.
This medical form is specifically for use in Vermont for requesting prior authorization for certain medical procedures or treatments.
This form is used for requesting prior authorization for bone resorption inhibitors injectables in the state of Vermont.
This form is used for requesting prior authorization for a brand name medication in Vermont.
