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