Utah Department of Health and Human Services Forms

This document is a cover sheet for the Core Competency Curriculum for Administrative Rule 432-270 in Utah.

This document is for obtaining authorization and consent to release information from the Utah Child Abuse Central Registry. It is used to request access to information related to child abuse cases in Utah.

This form is used for requesting a DNA sample in the state of Utah. It collects necessary information for processing the request.

This document is used to acknowledge the decision and understanding of a patient undergoing a hysterectomy procedure under the Utah Medicaid program.

This document provides information about the repair or replacement of durable medical equipment in Utah.

This document is used for an independent physician review for extended care in the state of Utah. It helps to assess and determine the need for extended care services and treatment for patients.

This Form is used to request a State Impartial Hearing in Utah.

This document is a request for administrative review regarding a specific agency action in the state of Utah.

This form is used for requesting records from the local government in the state of Utah.

This document is designed for expectant mothers in Utah to monitor and record their baby's movements during pregnancy, assisting healthcare providers in tracking fetal health.

This document is a provider access agreement for a managed care organization in the state of Utah. It outlines the terms and conditions for healthcare providers to participate in the organization's network.

This document is an agreement that allows health care providers in Utah to access certain medical services.

This document is used for logging temperature readings in the measurement unit of Celsius in the state of Utah.

This document is used for medical questionnaires for the Kurt Oscarson Children's Organ Transplant Fund (KOCOTF) in Utah. It helps gather important medical information for individuals seeking organ transplants for children.