Healthcare Documents

This file contains the Phonak Virto B and CROS B order form for custom hearing instruments. It provides step-by-step instructions on how to complete the form. The form includes patient information, technology selection, and additional product options.

This document provides detailed information and frequently asked questions about leaves of absence and other employment-related matters due to COVID-19 for Kaiser Permanente members.

This document provides comprehensive instructions on how to download, set up, and use the pMD app on your mobile devices. It includes detailed steps for enabling video and audio settings, resetting your password, and troubleshooting common issues. Additionally, it provides information about the app's functionality and support.

The District of Columbia Medicaid 719A form is used to request authorization for medical and surgical services for Fee-for-Service Medicaid beneficiaries. The form includes sections to certify face-to-face encounters, request various services, and document necessary provider information. It is essential for proper documentation and request approval.

This file contains guidelines for pre-visit planning as outlined by the Adirondacks ACO. It includes measures, standardized specifications, and recommendations for practice teams. The document provides details on communication processes and planning care.

A comprehensive baseline assessment form for patients starting radiation therapy. This form includes medical history, social history, and various assessments. It's essential for documenting patient health information before therapy.

This Medication Request Form is used by physicians and pharmacy providers to obtain coverage for listed exceptions. Complete the form and fax it to Health New England Pharmacy Services. Contact Health New England Member Services for any questions.

This guideline ensures that all infants born at ANMC are safely and legally identified and banded at birth. It outlines the procedure to be followed for infant identification. The guideline also includes the steps to be taken in different scenarios during the birth admission.

This form allows patients to authorize Henry Ford Health System to release their medical information to a specified recipient. It includes details on fees, types of information to be disclosed, and patient rights. Complete the form to facilitate the transfer of medical records.

This document is the Utah Small Employer Health Insurance Application form. It contains sections for employer and employee information, health statement, and acknowledges the responsibilities of both parties. Essential for small businesses in Utah for health insurance application.

This file contains the application form for the Community Homes for Opportunity (CHO) program, which provides stable, affordable, appropriate housing and support services to individuals living with serious mental illness.

This document is the Bonitas 2023 Individual Medical Aid Application Form. It includes all necessary sections for providing personal details, choosing medical aid options, and adding dependants. The form also contains medical and employment information required for processing.