Select material to view


CL-1170ADA Service Medical Authorization
AE-6007-NYCertification of Major Medical Insurance, Basic Hospital Insurance and Basic Medical Insurance Coverage
MK-1247Family & Medical Leave Act (FMLA) HR Handbook
AE-6009Hospital Indemnity Coverage Certification of Medical, Hospital, and surgical coverage
CS-1109Letter of Medical Necessity For Flexible Spending Accounts
6653-03Medical Authorization Form (HIPAA) - Arizona
6720-03-CAMedical Authorization Form (HIPAA) - California
6721-03-CAMedical Authorization Form (HIPAA) - California
6742-05Medical Authorization Form (HIPAA) - California
6614-03Medical Authorization Form (HIPAA) - Generic
6720-03Medical Authorization Form (HIPAA) - Generic
6721-03Medical Authorization Form (HIPAA) - Generic
6639-03Medical Authorization Form (HIPAA) - Maine
6720-03-ME-VTMedical Authorization Form (HIPAA) - Maine and Vermont
6721-03-ME-VTMedical Authorization Form (HIPAA) - Maine and Vermont
6674-03Medical Authorization Form (HIPAA) - Minnesota
6720-03-MNMedical Authorization Form (HIPAA) - Minnesota
6721-03-MNMedical Authorization Form (HIPAA) - Minnesota
6717-03Medical Authorization Form (HIPAA) - New Jersey
6681-03Medical Authorization Form (HIPAA) - New Mexico
6720-03-NMMedical Authorization Form (HIPAA) - New Mexico
6721-03-NMMedical Authorization Form (HIPAA) - New Mexico
6720-03-NYMedical Authorization Form (HIPAA) - New York
6721-03-NYMedical Authorization Form (HIPAA) - New York
6676-03Medical Authorization Form (HIPAA) - Vermont
6661-03Medical Authorization Form (HIPAA) - Virginia
CL-1193Medically Necessary Contact Lenses Request form
CL-1088-PFLPaid Family Medical Leave Authorization
CL-1088-PFL-SPPaid Family Medical Leave Authorization - Spanish