Healthcare Documents

This file provides detailed instructions on how to submit your biometric screening verified form for the 2023 Annual Wellness Assessment program. Make sure your biometric screening is done between Aug. 1, 2022, and July 31, 2023. Follow the steps mentioned to properly fill out and submit the form.

This file is a fall risk assessment form developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center. It includes questions to help determine an individual's fall risk based on their medical history and current health status. Users should discuss their results with their doctor.

This file provides detailed instructions on how to renew your nurse aide registration. Follow the step-by-step guide to complete the renewal process efficiently. Ensure you have all the required documents ready before starting the application.

This document is used to request access to and copies of protected health information at Nationwide Children's Hospital. Each section must be completed entirely to avoid processing delays. Sensitive information requests require additional authorization.

This document is a Quick Reference Guide for the Centers for Medicare & Medicaid Services (CMS) describing steps for FFM Registration and Assister ID Verification. It includes instructions for new user registration, multi-factor authentication setup, and ID verification for Assisters. Follow this guide to complete the mandatory annual Assister Certification training.

The Individual Transportation Participant (ITP) Agreement is required for participants in the Individual Transportation Program. The document includes instructions, required forms, and important information on how to schedule and receive payment for transportation services provided. It needs to be filled out, signed, and returned along with necessary documents.

This file provides a checklist for Comprehensive Error Rate Testing (CERT) in Skilled Nursing Facilities (SNF). It includes the necessary documentation required to support claims under the Health Insurance Prospective Payment System (HIPPS). The checklist aims to ensure thorough and accurate submission of all required forms and records.

This file is the Practitioner Disease Report Form for notifying the Florida Department of Health of a reportable disease or condition. It includes sections for patient information, medical information, and provider information. It also outlines the diseases and conditions that must be reported.

This file is a Request for Information (RFI) application designed for ancillary and hospital providers to apply for participation in the CareFirst networks. It includes provider information, agreement contacts, legal notices, credentialing, directory information, billing, payee information, general information, and more. Proper completion is crucial for timely processing.

The Adult Care Home Medication Administration Records (MAR) book includes essential medication administration guidelines and physician orders. Each resident's section is tabbed for easy access to documentation such as signed physician orders, medication guidelines, and controlled substance logs. This file ensures that all MARs are up-to-date and properly filed.

This file is a Certificate of Medical Necessity for the use of Dexcom Continuous Glucose Monitoring System. It contains patient information, physician information, medical necessity statement, and clinical indications. The document also serves as a prescription for Dexcom devices and supplies.

The Florida Medicaid Provider Bulletin provides important updates and instructions for Medicaid providers, including how to renew their enrollment online. It also contains messages from authorities and essential compliance information. Stay updated with the latest procedures and requirements with this comprehensive guide.