Healthcare Facilities Templates

This Form is used for obtaining consent to administer medical treatment or medications in the Northwest Territories, Canada.

This form is used for Comprehensive Outpatient Rehabilitation Facilities (CORFs) to report their certification to participate in the Medicare Program.

This form is used for documenting the transfer of patients between healthcare facilities in North Dakota and recording any infection control measures taken during the transfer.

This document provides information on the nursing personnel during the second quarter in Nevada.

This document is used for certifying the medical necessity of hospital beds in Rhode Island. It is required to ensure that patients who need a hospital bed at home receive proper medical care.

This Form is used for applying for a Narcotic Treatment Program for controlled substances in the state of South Carolina.

This Form is used for registering or deleting X-ray producing machines in South Carolina.

This Form is used for reporting cases of hepatitis in Oklahoma as per the requirements of the Oklahoma State Department of Health (OSDH).

This document is a sample checklist for South Carolina employees of SCDDSN (South Carolina Department of Disabilities and Special Needs) regarding the administration of buccal (oral) medication. It outlines the steps and requirements for properly handling and administering this type of medication.

This form is used for applying for a license to operate an ambulatory surgery center in South Dakota.

This form is used for reporting the hospice utilization in Florida for the July-December period.

The purpose of this type of sample is to inform a patient that their doctor will no longer provide medical care for them.

This form is used for applying for an adjustment to the scope-of-service rate for Federally Qualified Health Centers in Colorado. It also includes an attestation.

This form is used for obtaining prior authorization for pharmaceuticals that will be administered in an outpatient hospital setting in Colorado.

This Form is used for reporting credit balances to Medicare, which refers to overpayments that need to be refunded. It helps healthcare providers accurately calculate and reconcile outstanding credit balances.

This document outlines the plan for safely handling and disposing of biomedical waste in the state of Florida. It includes guidelines and procedures to ensure proper management of potentially hazardous waste materials generated by healthcare facilities.

This Form is used for facilities enrolling with Health First Colorado in Colorado to provide attestation of their services and eligibility.

This document is a log for off-site healthcare activities in the state of Georgia. It is used to track and record healthcare services provided outside of a traditional healthcare facility.

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 outlines the protocol for managing infectious diseases in the state of Iowa. It provides guidelines and procedures to help prevent the spread of diseases and protect public health.

This document is used to determine the level of care required for individuals in Pennsylvania. It helps in evaluating the appropriate level of medical or long-term care services needed for an individual.

This document is used for hospitals and general infirmaries in South Carolina to report information to the Department of Health and Environmental Control (DHEC). It is a form that helps collect data related to healthcare facilities in the state.

This document is for applying for a license to operate a residential treatment facility in Washington.

This Form is used for assessing the Covid-19 status of patients being transferred from a hospital to a post-acute care facility in Texas.

This Form is used for requesting nursing facility rates in the state of Alabama.

This form is used for exempt ESRD facilities in Texas to attest their compliance with the Life Safety Code guidelines.

This form is used for submitting complaints regarding healthcare facilities in Wyoming.

This type of document is used for conducting a patient audit in West Virginia. It helps gather information about patient care and ensure compliance with regulations.

This document is a compilation of resources related to hospitals and COVID-19. It provides information on testing, treatment options, and support services available during the pandemic.

This document explores the CMS flexibilities given to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to combat the COVID-19 pandemic. It discusses the measures and changes implemented to enhance healthcare services in these rural areas.

This document outlines guidelines and strategies for conducting widespread testing to help reopen America safely during the COVID-19 pandemic.