Healthcare Documents

This file contains details and instructions about enrolling in the HUMIRA Complete program, along with information on prescription usage and safety. It provides a comprehensive guide for getting started with HUMIRA treatment, including insurance navigation, prescription fulfillment, and injection training. It also includes important safety information and how to fill out the enrollment and prescription form.

The South Denver Podiatry Patient Update Form is used to update personal information, insurance details, and medical history. This form helps ensure that your records are accurate and up-to-date. It's essential for existing patients who have had address or insurance changes in the past year.

This file provides a sample superbill converted to ICD-10-CM by AHIMA. It serves as an example for transitioning to a new coding system. Please return the form to the receptionist.

This file is a request form for massage therapy treatment. It includes sections for the patient's information, doctor's referral, and signatures. It is intended for patients who need a referral for medical massage.

This document provides detailed information about the transportation, lodging, and meals benefits available to Presbyterian Centennial Care members. It covers how to use these benefits, answers frequently asked questions, and provides contact information for further assistance.

This document is the 2015 catalog and order form for Humana's over-the-counter (OTC) health and wellness products. It provides instructions on how to place an order through RightSource. You will also find information on benefit limits and payment methods.

This file is an application form for the Lighthouse Women's Residence Program. It includes sections for referral information, client information, children's details, diagnosis, and treatment history. All information must be completed by a referring party before being considered for admission.

This form is intended for patients or their legal guardians to waive liability and refuse medical care or transportation recommended by the EMS. It details the risks involved in refusing care and requires the patient's or guardian's signature, along with witness signatures. The form releases EMS from liability and holds them harmless.

The PhilHealth Premium Payment Slip is used for paying health insurance premiums. This form helps members provide required information for payment processing. It is crucial for maintaining active health coverage.

This file provides information about the dental examination requirements for students entering Pre-K and Kindergarten. It includes guidelines on when the examination should be completed and how to provide proof. It helps ensure children have good oral health for school success.

This file is for employees seeking a medical exemption from COVID-19 vaccination in Florida. It includes sections for both the employee and their medical provider to fill out. The completed form must be submitted to the employer to opt-out of a vaccination mandate.

This file is a school immunization consent form for Volusia County, Florida. It gathers essential details about the student and the parent or guardian. The form also records the necessary vaccines to be administered.