Healthcare Documents

The Person-Centered Service Plan Template is designed to help individuals outline their preferences, strengths, goals, and needs while identifying available services. It is used in accordance with Person-Centered Service Planning Guidelines. The template allows users to document necessary details, unmet service needs, and informal supports.

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 provides a notice of Medicare non-coverage, detailing the end of coverage for specific services and instructions on how to appeal the decision. It includes contact information, appeal rights, and steps to request an immediate appeal. The form must be filled out and signed by the patient or their representative.

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 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.

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 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 document provides detailed diagnostics and follow-up procedures for economic benefits related to Cafesalud in 2019. It includes methods for organizational development, strategic management, and service auditing. Authors include professionals from various health and administrative backgrounds.

The CAGE Substance Abuse Screening Tool helps clinicians identify potential substance abuse issues. Using a series of key questions, this tool aids in determining whether substance abuse exists and needs to be addressed. It includes instructions for both alcohol and drug use assessment.

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 document provides guidelines for the IDD Qualifying Diagnosis Certification form. It explains the process for completing and submitting the form. It is intended for care coordinators, applicants, and qualified professionals.

This file contains a Physician's Treatment Summary Form for accident, cancer, and/or sickness. It guides users on registering, submitting outpatient treatment, or surgeries. The form includes necessary fields for patient, physician, and treatment details.