Healthcare Documents

This file provides detailed information on the required steps and data for professional providers to submit claims to Anthem Blue Cross. It outlines key information needed on the CMS-1500 Health Insurance Claim Form or its electronic equivalent. Compliance with these guidelines is necessary to ensure timely and accurate reimbursement.

This file contains nutrition assessment forms and questionnaires for Odom Health & Wellness. It includes sections for demographic data, health history, and more. It is used to gather detailed information to help in nutritional guidance.

This file is an order form for ImprimisRx ophthalmic topical medications. It includes sections for patient information, shipping options, medications required, instructions for use, prescriber verification, and payment details. It is used by healthcare providers to order compounded medications for their patients.

The MOD Big 5 ACT Data Collection Form is designed for recording data of live-born infants delivered at or between 23 and 33 weeks of gestational age. Complete this form for the first live-born baby delivered in case of multiple deliveries. The form collects essential details including mother's race, primary payment source, and details of any ACT medication given.

This document provides detailed information and instructions for patients undergoing a surgical awake abortion procedure at Planned Parenthood. It includes essential guidelines to prepare for the appointment, necessary documents to bring, and what to expect during the visit. Follow these instructions to ensure a smooth and successful appointment.

The PAINAD Scale helps assess pain in individuals with advanced dementia. It measures five specific items, each scored from 0 to 2. This guide provides the detailed scoring criteria for each item.

This file is used for documenting the discharge details of a patient from a hospital. It includes information such as patient's name, date of birth, contact details, follow-up appointment, and any medical conditions or accommodations required.

This form is used to declare support provided by someone other than a spouse. It includes sections for personal details, type of support, and signatures. It is an official government record and giving false information may result in criminal action.

This is a pre-admission screening and resident review (PASRR) Level I screening form required by the New Jersey Department of Human Services for all applicants prior to nursing facility admission. The form identifies mental illness and intellectual/developmental disabilities. Proper submission is necessary to avoid forfeiture of Medicaid reimbursement.

This file provides essential information about Methodist Le Bonheur Healthcare, its mission, vision, values, and expected behaviors. It is a comprehensive guide for employees and affiliates. Users can understand the core principles and guidelines mandated by the healthcare system.

This form is used to document the delayed certification or recertification of a physician for a patient's need for continuing care. It requires the physician to provide the reason for the delay and attest to the patient's need for skilled nursing services. The form includes fields for patient information, admission and discharge dates, and a summary of the patient's condition and care.

This form is used by admitting physicians for VIVA HEALTH's inpatient and outpatient precertification. It captures essential patient information, diagnosis, treatment plans, and requested length of stay. The form ensures that the requested healthcare services align with the member's benefit plan.