Health Services Templates

This form is used for requesting pediatric specialty care services in Nevada.

This document is a letter used by the Washington Department of Social and Health Services to request information from individuals who speak Haitian Creole.

This form is used for applying for the Health Services Housing Program in Washington. It is a program designed to provide housing assistance to individuals in need of health services.

This form is used for applying to the Health Services Housing Program in Washington. It is available in both English and Spanish.

This document is an application form for obtaining a license to operate an assisted living facility in the state of Washington.

This form is used for submitting a retroactive claim for Medicaid in the state of Texas.

This form is used for reporting and reviewing the utilization of day activity and health services in Texas. It helps track and analyze the utilization of services to inform decision-making and improve the quality of care provided.

This Form is used for recording the attendance of individuals in Day Activity and Health Services in Texas on a daily basis.

This form is used to apply for the Medicaid Buy-In program for children in Texas.

This Form is used for requesting information from the Washington State Department of Social and Health Services. It is specifically designed for Burmese-speaking individuals.

This document is used for the identification and screening of individuals in New Mexico who may require Level I services under the PASRR program.

This form is used for referring individuals to the Community Health Network Program in Rhode Island.

This document is a meeting notice for the Children's Integrated Services program in Vermont. It provides details about an upcoming meeting related to services for children.

This type of document provides a review of health-related services in Alaska. It offers information and feedback on various healthcare services available in the state.

This type of document allows individuals in Alaska to refer themselves to the Medicaid Coordinated Care Initiative (AMCCI) for coordinated healthcare services.

This form is used for requesting changes to the Medical Services Plan (MSP) in British Columbia, Canada.

This form is used for denying claims for emergency medical services for aliens in New Mexico. It is available in both English and Spanish.

This form is used for referring individuals to the Medicaid Health Home program in South Dakota.

This Form is used for applying for Medicaid eligibility under the Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program in Pennsylvania.

This document is a request for medical care at a facility called Doc Host in Oklahoma.

This form is used for referring individuals in South Carolina to rehabilitative behavioral health services.

This form is used for requesting data related to HIV/STD services in Oklahoma. It allows individuals to submit a formal request to access specific information or statistics regarding HIV/STD prevention, testing, and treatment services in the state.

This document is used for applying for health services related to enteral feeding in New Brunswick, Canada. It provides the necessary information and forms to request assistance with enteral feeding for individuals in need.

This Form is used for requesting reimbursement for continuing education expenses related to health services in the state of Washington.

This form is used for accessing health services for children attending nonprofit private schools in Connecticut. It allows parents to request assistance and support for their children's health needs while attending these schools.

This Form is used for updating or discharging a patient in Connecticut's Developmental Disabilities Administration Program (DDAP).

This document is an application for the Healthy Children Initiative in Nunavut, Canada. It is used to apply for funding and support for programs and initiatives aimed at promoting the health and well-being of children in the region.

This type of document is used by individuals or companies in Illinois who want to become a provider of stretcher van services. It outlines the application process and requirements for becoming a licensed stretcher van provider in the state.

This document is used to keep track of the release of restraints in health services in Iowa. It helps ensure that the restraints are used appropriately and released in a timely manner.

This document is a health services procedural checklist for documenting exposure incidents for Nurse Directors or their designees in the state of Iowa. It provides a standardized process for documenting incidents of exposure to infectious agents or hazardous substances in healthcare settings.

This document outlines the procedural checklist for potential exposure incidents related to health services in the state of Iowa. It provides guidelines and steps to be followed in case of a potential exposure incident to ensure the safety and well-being of individuals involved.

This form is used for assessing eligibility for a Medicaid waiver program in Kentucky.

This form is used for reporting pediatric HIV/AIDS cases in Michigan. It is a confidential case report form.