Friday, November 15, 2019

Sample legal forms and business documents

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Centers For Medicare And Medicaid Services

Form TitleCoverage
1-800-Medicare Authorization To Disclosure Personal Health Information Official Federal Forms
Accredited Hospital Allegation(s) Report Official Federal Forms
Acknowledgment Of Request For Medicare Medical Insurance Termination Official Federal Forms
Acknowledgment Of Request For Premium Hospital Insurance Termination Official Federal Forms
Addendum To Data Use Agreement (DUA) Official Federal Forms
Addendum To The Medicaid Agency Data Use Agreement (DUA) Official Federal Forms
Advance Beneficiary Notice (ABN) Official Federal Forms
Adverse Action Extract For SNFs And NFs Official Federal Forms
Advisory Panel On Ambulatory Payment Classification Groups Official Federal Forms
ALJ Medicare Case Folder (CMS) Official Federal Forms
Ambulatory Surgical Center Request For Certification In The Medicare Program Official Federal Forms
Ambulatory Surgical Center Survey Report Official Federal Forms
Appointment Of Representative Official Federal Forms
Authorization For State Agency Hospice Validation Survey Official Federal Forms
Authorization For State Agency Hospice Validation Survey Official Federal Forms
Calendar Worksheet-Prescribed Visits Official Federal Forms
Certificate Of Data Destruction For Data Acquired Official Federal Forms
Certificate Of Medical Necessity Official Federal Forms
Certificate Of Medical Necessity Continuation Form Official Federal Forms
Certificate Of Medical Necessity Enteral Nutrition (DMERC 10.02B) Official Federal Forms
Certificate Of Medical Necessity Hospital Beds (DMERC 10.02A) Official Federal Forms
Certificate Of Medical Necessity Pneumatic Compression Devices Official Federal Forms
Certificate Of Medical Necessity Possitive Airway Pressure (PAP) Devices Official Federal Forms
Certificate Of Medical Necessity Seat Lift Mechanisms Official Federal Forms
Certificate Of Medical Necessity Transcutaneous Electrical Nerve Stimulator (TENS) Official Federal Forms
Cetificate Of Medical Necessity Osteogenesis Stimulators Official Federal Forms
CLIA Adverse Action Extact Official Federal Forms
Clinical Laboratory Improvement Amendments Of 1988 (CLIA) Application For Certification Official Federal Forms
CMS Death Record Review Data Sheet Official Federal Forms
CMS Nursing Complement Data Official Federal Forms
Competitive Acquisition Program (CAP) For Medicare Part B Drugs CAP Physician Election Agreement Official Federal Forms
Compliance Plan For Accounting For Disclosures Of Privacy Protected Data From A System Of Records (SOR) Official Federal Forms
Comprehensive Outpatient Rehabilitation Facility Report For Certification To Participate Official Federal Forms
Comprehensive Outpatient Rehabilitation Facility Survey Report Official Federal Forms
Consent For Home Visit Official Federal Forms
Consent For Home Visit For Pace Services Evaluation Official Federal Forms
Data Collection Medical Staff Coverage Official Federal Forms
Data Use Agreement (DUA) (Data Containing Individual-Specific Information) Official Federal Forms
Data Use Agreement (DUA) (Limited Data Sets) Official Federal Forms
Data Use Agreement (DUA) Update To Existing Data Use Agreement Official Federal Forms
Data Use Agreement (State) Official Federal Forms
Detailed Explanation Of Non-Coverage Official Federal Forms
Disclosure Of Ownership And Control Interest Statement Official Federal Forms
DSH Data Use Agreement Official Federal Forms
DSH Data Use Agreement For Cost Reporting Periods That Include December 8, 2004 And Thereafter Official Federal Forms
EDI Enrollment Form Official Federal Forms
EDI Registration Form Official Federal Forms
Electronic File Interchange Organization (EFIO) Certification Statement Official Federal Forms
Electronic Funds Transfer (EFT) Authorization Agreement Official Federal Forms
End Stage Renal Disease Medical Evidence Report Medicare Entitlement And-Or Patient Registration Official Federal Forms