Healthcare Provider Templates

This Form is used for conducting a physical assessment of individuals in the state of Nevada.

This document is for Maryland residents and helps them make decisions about their health care. It is a worksheet that guides individuals through the process of determining their preferences for medical treatment and end-of-life care.

This form is used for healthcare providers in Delaware to respond to an accommodation request made by a patient.

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 document provides information about the privacy practices regarding client medical information in Washington. It is available in English and Mongolian.

This document provides information regarding the privacy practices for client medical information in Washington state. It is available in both English and Mandinka languages.

Individuals who reside in British Colombia may use this form when they would like to apply to enter the Medical Service Plan (MSP).

This Form is used for obtaining prior authorization for medications at IHS and 638 Tribal Facilities/Pharmacies in Arizona.

This document certifies the standards of care for medical providers in Alaska. It ensures that healthcare professionals follow guidelines for patient care.

This form is used to authorize the release of personal information in the state of Maryland.

This Form is used to request prior authorization for antihemophilia agents in Nevada. It helps ensure that patients receive the necessary medications for treating hemophilia.

This form is used for ensuring the confidentiality of patient records in Texas.

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 document is used for expressing your healthcare wishes in Alaska. It allows you to designate a healthcare power of attorney and specify your healthcare preferences in case you are unable to make decisions for yourself.

This document provides guidelines and protocols for handling highly susceptible populations in Alaska to ensure their safety and well-being. It outlines standardized operating procedures that should be followed to effectively cater to the unique needs and vulnerabilities of these populations.

This type of document is used for applying for enrollment as a homemaker provider in the state of Arizona.

This document is used to enroll as a healthcare provider in Arizona if you are located out-of-state.

This form is used for healthcare providers in Iowa to apply for enrollment as an ordering or referring provider.

Individuals may use this letter to disagree with the information presented in their medical bill and demonstrate their desire to dispute it.

This form is used for registering practitioners in the province of British Columbia, Canada.

This form is used for assigning payment and authorizing the medical director for diagnostic facility services in British Columbia, Canada.

This form is used for applying for the Teleplan service in British Columbia, Canada.

This letter authorizes another individual to be responsible for the medical decisions and treatment of the person named in the letter.

A medical specialist may use this document to refer their patient to a psychiatrist.

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

This form is used for authorizing medical procedures in the state of Louisiana.

This form is used for EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) visits for individuals aged 11-21 in Mississippi. It is a required form for eligible individuals to receive comprehensive health services.

This document is used for making adjustments to healthcare claims in the state of Virginia.

This form is used for consenting to receive the Covid-19 vaccine in the state of New Mexico.