Free Health Care Legal Forms

  • FREE 2007 Pub 53, Utah Sales Tax Info For Health Care Providers
  • ... or rules. Sales Tax Information for Health Care Providers Utah State Tax Commission ... publication provides tax information relating to health care providers. General sales and ... aids, or 4. dental prostheses. Health Care Facilities Under certain conditions ...
    State: Utah   Category: Tax Forms

  • FREE Pub-6 Mental Health Commitments (11-07).indd
  • ... a hospital or other type of health care center for treatment of his ... case and the opinions of mental health professionals (for example, psychiatrists) who have ... 99603 235-8171 Bethel: Fairbanks: Behavioral Health Regional Offices Juneau: Central Region P ...
    State: Alaska   Category: Court Forms - State

  • FREE Name Of Medical Care Provider
  • ... 94612 Report of Suspected Medical Care Provider Fraud Labor Code section ... State: Zip Code: Type of health care provider: ____________________________________________________________ 1 DWC ... than one injured worker's care is involved, please attach additional ...
    State: California   Category: Workers Compensation

  • FREE Department Of Health & Family Services
  • ... HEALTH SERVICES Division of Public Health F-00051 (3/09) STATE OF WISCONSIN ... Wisconsin Immunization Registry (WIR) with other health care providers directly involved with your ... Name of Physician BadgerCare Plus No Health Insurance Name of School Insured, ...
    State: Wisconsin   Category: Health Care

  • FREE Medicaid Health Insurance Information, Hcf 10115
  • ... HEALTH SERVICES Division of Health Care Access and Accountability F-10115 (07/08) ME MEDICAID HEALTH INSURANCE INFORMATION 1. 2. 3. ... and are covered by other health insurance, whether or not the ... for the cost of medical care which are available under a ...
    State: Wisconsin   Category: Health Care

  • FREE Cardiovascular Lipid Consultation Record, Dph 43015
  • ... Please complete section A for your health care provider when you go for ... : Name of Specialist or Primary Care Provider (PCP): PCP Address: PCP Telephone ... Treatment Requires Treatment Requires Treatment Primary Care Provider Name (Print): SIGNATURE ­ Primary ...
    State: Wisconsin   Category: Health Care