Healthcare Documents

The LIC Policyholders' Mandate Form enables policyholders to authorize premium payments via Electronic Clearance Service. It streamlines the payment process for life insurance premiums through auto-debit from bank accounts. Completing this form is essential for maintaining an active policy and ensuring timely premium payments.

This document outlines the policies for Transition of Care and Continuity of Care for UnitedHealthcare members. Learn how to apply for extended coverage with your current health care professional if they are out-of-network. Follow the instructions for coverage related to specific medical conditions and important deadlines.

This file is an application for Personal Injury Protection benefits. It provides the necessary form and details needed for submission. Individuals seeking benefits under an insurance policy should complete this application.

This document provides essential information regarding the waiver provider signature requirement for Ohio Medicaid. It outlines responsibilities, submission methods, and the importance of consent in service plans. Understanding this requirement is crucial for providers working with Ohio's Medicaid waivers.

This file is a comprehensive template designed for suicide risk assessment. It includes screening questions and risk factors. Ideal for clinical settings to evaluate suicidal ideation and behaviors.