Healthcare Documents

The CAPS-5 Past Week is an instrument for assessing PTSD symptoms occurred in the past week. It helps compare PTSD symptoms over time. It should not be used for diagnosing PTSD.

This file outlines the steps members of Simply Healthcare Plans need to follow to appeal a decision regarding their Medicaid Managed Medical Assistance or Long-Term Care services. It provides detailed information on how to file an appeal, what to expect after submitting an appeal, and what to do if expedited processing is needed. The guide also includes contact information for further assistance.

The SNAP-IV 26 is a rating scale developed by James M. Swanson, Ph.D. from the University of California, Irvine. It is used to assess attention and behavior issues in children. The scale is typically completed by teachers or parents.

This file contains instructions for submitting a Primary Care Provider form to Catapult Health. It includes details on how to submit via secure email, fax, or mail. Active employees and retirees can use this form to receive credit toward their wellness incentive.

This Vaccine Intake Consent Form from CVS Pharmacy is required for receiving a vaccine. It includes fields for personal information, insurance details, and information about the vaccine to be received. It also contains screening questions and consent statements.

The Controlled Substance Count Sheet is a vital document used to track the management of controlled substances. It includes important fields like individual's name, medication strength, prescription number, date, time, and quantity. This sheet ensures accurate record-keeping and compliance with regulations.

This file is used for applying or updating a National Provider Identifier (NPI) which is required for healthcare providers. Users should provide accurate and complete information to avoid delays in processing. It also includes penalties for falsifying information and certification statements.

The Lilly Cares Foundation Patient Assistance Program Diabetes Prescription Form is used for prescribing various diabetes medications provided by Lilly. It includes fields for patient and prescriber information, as well as the medications prescribed. This form ensures that patients receive their medications through the Lilly Cares program.

This file provides detailed instructions on how providers can request claim reconsiderations with BlueCross BlueShield of Tennessee. It outlines the steps needed, the documentation required, and the appeal process. Ideal for providers seeking to understand the reconsideration process.

This document is an application form for obtaining a birth certificate from the Arkansas Department of Health. It includes fields for personal information, parental details, and identification requirements. The form provides instructions for submission via mail, online, phone, or in-person.

This file is a Weight Watchers Proof of Participation form for PEBB employees. It must be completed and submitted to qualify for another Weight Watchers series. It requires proof of participation in at least 10 weeks of the previous series.

This file contains a list of McLaren Health Plan service codes that require preauthorization, effective June 1, 2024. It includes details on autism services, auditory and oral procedures, behavioral health, and cosmetic procedures. Refer to this document for specific service codes and authorization requirements.