Fill and Sign Legal Forms and Templates

This Form is used for requesting home modifications or special medical equipment in Rhode Island. It helps individuals with disabilities or medical conditions make their homes more accessible.

This Form is used for referring requests for home stabilization services in Rhode Island.

This Form is used for residents of Rhode Island to request prior authorization for home modifications, special medical equipment, and minor environmental modifications.

This document provides detailed information about the NDC (National Drug Code) Detail Attachment for the Rhode Island Medicaid Program in Rhode Island. It outlines the specifics of drug codes and their attachment to the program.

This form is used for obtaining prior authorization for Medicaid services in Rhode Island. It helps ensure that necessary medical treatments are approved and covered by Medicaid.

This document provides instructions for completing the Rhode Island Medicaid Prior Authorization Form. It is used to request approval for specific medical services or treatments before they can be covered by Medicaid in Rhode Island.

This document is used to request prior authorization for durable medical equipment (DME) specifically for children in Rhode Island. It helps ensure that children have access to necessary medical equipment.

This document is used to certify the medical necessity of hearing aids in Rhode Island.

This form is used for requesting prior authorization in Rhode Island for home modifications and/or special medical equipment/rehab equipment.

This document provides answers to frequently asked questions regarding the disclosure of Medicaid benefits in the state of Rhode Island. Find information on eligibility requirements, coverage options, and more.

This Form is used for creating a linkage between the local education agency (LEA) and a provider in Rhode Island. It facilitates collaboration between educational institutions and service providers for the benefit of students.

This document is used for authorizing electronic financial transactions in Rhode Island. It allows individuals to set up automatic payments or transfers through their bank accounts.

This Form is used for providing information about a Template Information Card in Rhode Island.

This type of document is used for adding new members to an existing group insurance enrollment in Rhode Island.

This document certifies that a home care agency provider in Rhode Island complies with the requirement of providing transportation services to individuals receiving Medicaid long term services and supports.

This Form is used for enrolling new groups in Rhode Island for Rite Share Co-insurance and Deductible Only plans.

This form is used for the Director of Nurses to make a statement regarding the need for hearing aids in Rhode Island.

This form is used for submitting a waiver or rehabilitation claim in the state of Rhode Island. It allows individuals to request exemptions or assistance for certain programs or services.

This form is used for applying for preferred provider status (PPS) in Rhode Island for the treatment of Hepatitis C.

This Form is used for requesting an early refill of a prescription that was lost or stolen in Rhode Island.

This form is used for submitting a claim recoupment request in Rhode Island.

This document is for individuals who are interested in becoming a member of the Rhode Island Consumer Advisory Board. Apply now to have your voice heard and contribute to consumer protection in Rhode Island.

This type of document is used for voluntarily quitting a job in Rhode Island due to health or medical reasons.

This type of document is used for the discharge of a mortgage or lien in the state of Rhode Island.

This document is for school employees in Rhode Island who need to request time off during the semester or summer break.

This document provides information about the school vacation period for school employees in Rhode Island. It outlines the dates and duration of the vacation period, allowing employees to plan their time off accordingly.

This document is for employers in Rhode Island who need to refuse a work request from an employee.

This document is used to report a voluntary quit in Rhode Island when an employee is not paid the correct amount.

This type of document is used when an employee voluntarily leaves their job due to experiencing sexual harassment in the state of Rhode Island.

This document provides information about the military pension program in Rhode Island. It outlines the benefits and eligibility criteria for retired military personnel in the state.

This form is used for authorizing the release or obtaining of confidential information in the state of Rhode Island.

This document is used for referring individuals to Rhode Island's Nursing Home Transition Program, which helps individuals transition from nursing homes back to their homes or community-based settings.

This form is used for Level I identification for minors and individuals with developmental disabilities in Rhode Island.

This document is a sample Medicaid Managed Care Core Contract Attestation Statement for MCO Reporting Submission in Rhode Island.

This Form is used for making Medicare premium payments in Rhode Island.

This form is used for applying for state-funded assistance in Rhode Island to help pay for health care coverage.

This type of document is a verification checklist for the Child Care Assistance Program in Rhode Island. It helps in meeting the requirements and ensuring eligibility for the program.

This form is used for filing a discrimination complaint in Rhode Island.