Request for Pesticide Information From a Health Care Professional (Hcp) - Oregon
Medicare and Home Health Care
Form OHP505 Medicare/Medicaid Billing Invoice for Medical Practitioner Claims - Oregon
DA Form 4159 Request for Medical Care in a Federal Medical Treatment Facility Outside Department of Defense
Form IHS-917 Request for Correction/Amendment of Protected Health Information
Form HCFA-605 Request for Approval as a Hospital Provider of Extended Care Services (Swing-Bed) in the Medicare and Medicaid Programs
VA Form 10-5345 Request for and Authorization to Release Health Information
VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges
VA Form 10-0491J Request for Deferment for Advanced Education - Health Professional Scholarship Program (Hpsp) & Visual Impairment and Orientation and Mobility Professionals Scholarship Program (Viompsp)
VA Form 10-10163 Request for and Permission to Participate in Sharing Protected Health Information Through Health Information Exchanges
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-10106 Authorization to Disclose Personal Health Information Release Form
Form CMS-671 Long-Term Care Facility Application for Medicare and Medicaid
VA Form 10-0527-CHOICE Request and Authorization to Release Protected Health Information to the Choice Program
Reasonable Accommodation Request Form for Pesticide Examinations - Oregon
VA Form 10-5345A Individuals' Request for a Copy of Their Own Health Information
Form WH-380-E Fmla Certification of Health Care Provider for Employee's Serious Health Condition
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
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