Healthcare Documents

This file is an application to participate in the Comprehensive Perinatal Services Program (CPSP) by the California Department of Public Health. It includes sections for general information, provider details, list of practitioners, discipline-specific protocols, state-sponsored provider overview training, and attachments. The form must be completed and submitted to your local CPSP Perinatal Services Coordinator.

This form is used by parents or guardians to provide detailed health and medical history information for children and adolescents. It includes sections to be completed by both the parent/guardian and the health care practitioner. The form is essential for school enrollment and other child care services in NYC.

This file is a diabetes education and samples order form from BD Medical. It includes complimentary syringe and pen needle take-home kits and sample packs. Ideal for health care professionals managing diabetes patients.

This file includes a patient consent form for Genentech services. It guides patients on getting health insurance coverage, receiving optional education material and enrolling in assistance programs. The file includes detailed instructions, terms, conditions, and the authorization to use and disclose personal information.

This file contains the necessary form for submitting prior authorization requests to CalOptima. It includes sections for prescriber and patient information, medication details, and justification statements. Follow the instructions to complete the form accurately.

This document includes the requirements for nursing home licensure, guidelines for licensure application, and definitions relevant to the regulations. It is issued by the Agency for Health Care Administration.

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 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 document outlines the importance of the Do Not Resuscitate (DNR) Form, the steps to fill it out, and who needs it. It includes details on editing and sharing the form using PrintFriendly.

This document is a worksheet for parents or informants to fill out information required for the Arizona Certificate of Live Birth. It collects details about the child's birth, parents' information, and other relevant data. This form must be reviewed, signed and verified for accuracy.

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.

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.