Health Care Provider Templates

This document is used for requesting health information in Ontario, Canada.

This form is used for health care providers in Maine to reconcile their taxes.

This Form is used for transmitting medical bills in the state of Texas. It is used to submit medical bills and documents to the appropriate agencies for processing and payment.

Individuals may use a letter such as this as a reference when they would like to request a copy of their records from a medical organization where they have been treated.

This Form is used for requesting an appeal for a healthcare decision in Arizona.

This form is used for petitioning the court to appoint health care professionals in Maryland.

This document is used for certifying a treating healthcare provider to expedite the consideration of a patient's external review appeal in Nebraska.

This form is used for registering for the Ostomy Supplies Program in Prince Edward Island, Canada. It is for health care providers to sign up for the program and provide necessary information.

This form is used for obtaining a Health Care Provider Certificate of Serious Health Condition in the state of Oregon. It is necessary for individuals who need to take a leave of absence from work due to their own or a family member's serious health condition.

This form is used for employees in West Virginia to obtain supplemental certification from a healthcare provider for a medical leave of absence without pay and/or under the Federal Family and Medical Leave Act (FMLA).

This form is used for providing supplemental certification of a healthcare provider for a family member's serious health condition under the Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) in West Virginia.

This form is used for health care providers to report information in Vermont. It is used to provide details about a patient's health condition and treatment.

This form is used for health care providers in the City and County of San Francisco, California to obtain certification.

This document is used for providing an initial medical report by a health care provider in the state of Wyoming. It contains important information about the patient's medical condition and treatment plan.

This document certifies a health care provider in Alaska. It verifies their qualifications and credentials.

This Form is used for notifying a change in your health care provider in the state of Wyoming.

This Form is used for applying to become a health care provider in the state of California.

This type of form allows for an individual that resides in Florida to select themselves two agents that have the legal power to make medical decisions regarding the principal in emergency situations when the principal is not in a fit state to do so.

This form is used in New Hampshire to allow another individual (usually a close friend or relative) the power to make important medical choices on behalf of the principal.

This form is used for verifying health care provider diagnoses and is specifically for partners in health in New Hampshire.

This type of document is used for authorizing the release of personal information in the state of Indiana.

This document is used to inform workers in New York of their right to choose a healthcare provider authorized by the Workers' Compensation Board. It is available in both English and Urdu.

This form is used for health care providers in Delaware to apply for certification.

This type of document allows you to designate someone to make medical decisions for you in Oklahoma if you become unable to do so yourself.

This document outlines the procedures related to the protection of patient health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) in the state of Minnesota. It helps patients understand how their medical data can be used and disclosed, and how they can gain access to this information.