U.S. Department of Health and Human Services Forms

145
total templates

Documents

145

Form CMS-485 "Home Health Certification and Plan of Care"

Rate (4.4 / 5) 42 votes
Size: 31 KB
2 pages

This form is filled out by the patient's attending physician and used as a fiduciary document in order to authorize professional health services.

Form 8 "Certificate of Immunization" - Iowa

Rate (4.8 / 5) 48 votes
Size: 273 KB
2 pages

Form NIH-75 "Request for Translating Service"

Rate (4.4 / 5) 30 votes
Size: 1 MB
1 page

Form NIH-69 "Request for Services"

Rate (4.8 / 5) 8 votes
Size: 16 KB
2 pages

Form WIC-48 "Women, Infant and Children (Wic) Special Supplemental Nutrition Program" - Louisiana

Rate (4.7 / 5) 104 votes
Size: 97 KB
3 pages

Form HHS-691 "Request for Title 38 Physician and Dentist Pay (Pdp)"

Rate (4.7 / 5) 72 votes
Size: 1 MB
1 page

Form IHS-975 "Request for Ratification of Unauthorized Commitment (Uac)"

Rate (4.7 / 5) 26 votes
Size: 2 MB
10 pages

Form HHS-419 "Clearance of Employees for Separation or Transfer"

Rate (4.7 / 5) 60 votes
Size: 1 MB
6 pages

Form CMS-802 "Matrix for Providers"

Rate (4.6 / 5) 46 votes
Size: 120 KB
2 pages

Form PHS398 "Detailed Budget for Initial Budget Period Direct Costs Only"

Rate (4.3 / 5) 59 votes
Size: 206 KB
1 page

Form HHS-700 "Civil Rights Discrimination Complaint"

Rate (4.6 / 5) 49 votes
Size: 179 KB
8 pages

Form CMS-116 "Clinical Laboratory Improvement Amendments (Clia) - Application for Certification"

Rate (4.6 / 5) 25 votes
Size: 267 KB
10 pages

Form OMHA-119 "Withdrawal of Request for Administrative Law Judge (Alj) Hearing or Review of Dimissal"

Rate (4.5 / 5) 74 votes
Size: 1 MB
1 page

Form OMHA-100 "Request for Administrative Law Judge (Alj) Hearing or Review of Dismissal"

Rate (4.5 / 5) 82 votes
Size: 1 MB
2 pages

Form CMS-849 "Certificate of Medical Necessity - Seat Lift Mechanisms"

Rate (4.3 / 5) 79 votes
Size: 142 KB
2 pages

Form HHS-697 "Foreign Activities Questionnaire"

Rate (4.8 / 5) 63 votes
Size: 1 MB
2 pages

Form HHS-690 "Assurance of Compliance"

Rate (4.5 / 5) 69 votes
Size: 1 MB
1 page

Form IHS-810 "Authorization for Use or Disclosure of Protected Health Information"

Rate (4.4 / 5) 65 votes
Size: 1 MB
2 pages

Form NIH-334 "Work Order"

Rate (4.4 / 5) 23 votes
Size: 1 MB
1 page

Form PHS-838 "Commissioned Officers' Effectiveness Report"

Rate (4.8 / 5) 88 votes
Size: 1 MB
7 pages

Form HHS568 "Final Invention Statement and Certification"

Rate (4.4 / 5) 48 votes
Size: 1 MB
2 pages

Form IHS-963 "Request for Confidential Communication by Alternative Means or Alternate Location"

Rate (4.6 / 5) 70 votes
Size: 1 MB
1 page

Form IHS-913 "Request for an Accounting of Disclosures"

Rate (4.6 / 5) 34 votes
Size: 1 MB
1 page

Form IHS-917 "Request for Correction/Amendment of Protected Health Information"

Rate (4.4 / 5) 102 votes
Size: 1 MB
2 pages

Form HHS-520 "Request for Approval of Outside Activity"

Rate (4.7 / 5) 38 votes
Size: 2 MB
16 pages

Form HHS-521 "Annual Report of Outside Activity"

Rate (4.7 / 5) 69 votes
Size: 1 MB
10 pages

Form HHS-734 "Payment Information Report"

Rate (4.8 / 5) 33 votes
Size: 1 MB
1 page

Form HHS-719 "Request for Copy of the Record(S) in the Case File"

Rate (4.3 / 5) 72 votes
Size: 1 MB
3 pages

Form HHS-724 "Request to Correct, Amend, or Delete a Record(S)"

Rate (4.3 / 5) 34 votes
Size: 234 KB
1 page

Form HHS-720 "Request for Copy of Record(S) - Third-Party With the Individual Appellant's Consent"

Rate (4.7 / 5) 92 votes
Size: 1 MB
1 page

Form HHS-733 "Identity Verification"

Rate (4.3 / 5) 61 votes
Size: 1 MB
1 page

Form HHS-721 "Individual Appellant's Consent to Third-Party for Copies for the Individual Appellant's Record(S)"

Rate (4.7 / 5) 39 votes
Size: 1 MB
2 pages

Form 190 "Quantitative Liver Function Test Record"

Rate (4.7 / 5) 99 votes
Size: 85 KB
4 pages

Form CMS-807 "Surveyor Notes Worksheet"

Rate (4.7 / 5) 47 votes
Size: 69 KB
2 pages

Form HHS-687 "Consent for Sterilization"

Rate (4.6 / 5) 13 votes
Size: 113 KB
2 pages

Instructions for GSA Form SF-424 "Application for Federal Assistance"

Rate (4.3 / 5) 13 votes
Size: 42 KB
2 pages

Form FDA1571 "Investigational New Drug Application (Ind)"

Rate (4.8 / 5) 34 votes
Size: 2 MB
3 pages

Form NIH2590 "Request for Intramural Research Training Award (Irta)"

Rate (4.7 / 5) 24 votes
Size: 1 MB
1 page

Form NIH-2983 "Request for Turn-In"

Rate (4.5 / 5) 29 votes
Size: 1 MB
1 page

Form PHS-6349 "Institutional Assurance and Annual Report on Possible Research Misconduct"

Rate (4.6 / 5) 84 votes
Size: 1 MB
2 pages