Medicaid Managed Care Reenrollment Member Request Form - Rhode Island
Medicare and Home Health Care
Medicaid Health Plan Change Request Form - Rhode Island
Medical Immunization Exemption Certificate for Use in Health Care Facilities - Rhode Island
Appendix C Medicaid Managed Care Core Contract Attestation Statement for Mco Reporting Submission - Sample - Rhode Island
DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense
AF Form 1466 Request for Family Member's Medical and Education Clearance for Travel
Form HCFA-605 Request for Approval as a Hospital Provider of Extended Care Services (Swing-Bed) in the Medicare and Medicaid Programs
FCC Form 461 Rural Health Care (Rhc) Universal Service Healthcare Connect Fund Request for Services Form
FCC Form 462 Rural Health Care (Rhc) Universal Service. Healthcare Connect Fund. Funding Request Form
Form CMS-671 Long-Term Care Facility Application for Medicare and Medicaid
Form SSA-787 Physician's/Medical Officer's Statement of Patient's Capability to Manage Benefits
Form HCPC-FML Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) - Metropolitan Life Insurance Company
Form WH-380-F Certification of Health Care Provider for Family Member's Serious Health Condition Under the Family and Medical Leave Act
Form WH-380-E Fmla Certification of Health Care Provider for Employee's Serious Health Condition
Form 61-211 Prescription Drug Prior Authorization Request Form - L.a. Care Health Plan
VA Form 10-0137 VA Advance Directive: Durable Power of Attorney for Health Care and Living Will (English/Spanish)
Cuidado Infantil Autorizado: Consultor En Atencion a La Salud - Rhode Island (Spanish)
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