Forms Library

Health Forms

Health forms are private, healthcare documents individuals use to make decisions about, declare the status of, and track their health. Healthcare professionals also use healthcare documents to certify the health information of patients. Some healthcare documents require the signature of the patient and his or her doctor to be valid and legally binding.
Nebraska Power of Attorney for Health Care
Nebraska Power of Attorney for Health Care Nebraska Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Refusal to Donate Organs
Refusal to Donate Organs If a person or a family member would like to refuse to donate his tissues or organs even if he has an organ donor card, he may use a Refusal to Donate Organs form to revoke any documents stating his consent for organ donation.
Michigan Durable Power of Attorney for Health Care
Michigan Durable Power of Attorney for Health Care Michigan Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Authorization for Minor's Medical Treatment
Authorization for Minor's Medical Treatment Authorization for Minor's Medical Treatment is a legal document providing others temporary rights to seek and provide healthcare and healthcare decisions aside from parents or legal guardians.
Wisconsin Power of Attorney for Health Care
Wisconsin Power of Attorney for Health Care Wisconsin Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Weekly Bathroom Cleaning Checklist
Weekly Bathroom Cleaning Checklist This is a template used to create and fill-out a Weekly Bathroom Cleaning Checklist Form which is a document between a borrower and a lender containing details of the loan for record and tracking of payment.)
Health Declaration
Health Declaration A health declaration form is a query about the state of health of the proposed insured person.
Excuse Note
Excuse Note Fill your Excuse Note for Work or School.
8889 (2017)
8889 (2017) The given form must be completed by a healthcare professional who is conducting a PPD skin test. A PPD skin test, also known as Mantoux test, is recommended to determine whether the patient has developed an antibody response to the bacteria causing tuberc
South Carolina Statutory Health Care Power of Attorney
South Carolina Statutory Health Care Power of Attorney South Carolina Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
DD 2807-1 (2015-2017)
DD 2807-1 (2015-2017) The form is used by Military physicians to determine if applicants can be accepted or should be disqualified on medical groups.
Contact Tracing
Contact Tracing The Contact Tracing form will help track down people who are in danger of being exposed to the virus.
Nevada Statutory Durable Power of Attorney for Health Care Decisions
Nevada Statutory Durable Power of Attorney for Health Care Decisions Nevada Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
VA 10-10EZR - Health Benefits Update Form
VA 10-10EZR - Health Benefits Update Form The primary purpose of Form VA 10-10EZ, Health Benefits Update Form, is to request enrollment in the VA Health Care System (Apply for Medical Benefits). Typically, veterans who have NOT previously enrolled or applied for VA health care benefits should use this form.
NHS HC1 form
NHS HC1 form You can apply for the scheme as long as your savings, investments or property (not counting the place you live) don't exceed the capital limit
Authorization to Disclose Health Information
Authorization to Disclose Health Information This Authorization to Disclose Health Information authorizes a health care provider to disclose certain specific health information records to another (such as a prospective employer, insurance company or school).
Washington Statutory Health Care Directive
Washington Statutory Health Care Directive Washington Advance Health Care Directive assigns an individual(s) to act as your agent and decision-maker about your medical care. It sets forth the names, addresses, and telephone numbers of those who you grant the authority.
Oklahoma Advance Directive for Health Care
Oklahoma Advance Directive for Health Care Oklahoma Advance Health Care Directive assigns an individual(s) to act as your agent and decision-maker about your medical care. It sets forth the names, addresses, and telephone numbers of those who you grant the authority.
Organ Donation
Organ Donation If a person or a family member would like to donate his tissues or organs after his death, he may use an Organ Donation Form to consent for organ donation.
Fit to Work
Fit to Work A Fit to Work form is the form issued by Doctors to people when they are ill or injured.
Accident Claims Release form
Accident Claims Release form An Accident Claims Release is a form that sets forth the agreement between two parties to settle liabilities associated with the accident.
Texas Directive to Physicians on Behalf of a Minor
Texas Directive to Physicians on Behalf of a Minor Texas Medical Directive to Physician on Minor allows the patient to instruct the physician not to use artificial methods to extend the natural process of dying. Before signing the directive, the patient may ask advice from anyone.
CMS 40B English (2014-2017)
CMS 40B English (2014-2017) Medicare is managed by the Centers for Medicare and Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.
Hospital Discharge Paper
Hospital Discharge Paper Hospital Discharge Paper is used to show that patient was discharge from hospital or clinic after treatment and rest.
New Hampshire Statutory Durable Power of Attorney for Health Care
New Hampshire Statutory Durable Power of Attorney for Health Care New Hampshire Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Application for Disabled Person Placard (MV 474)
Application for Disabled Person Placard (MV 474) Eliminates the requirements for a person with a permanent disability to obtain a new physician's certification in order to have his or her special license plate or parking ID placard renewed.
Child Medical Consent
Child Medical Consent A Child Medical Consent Form is a legal document that provides someone other than the parent or legal guardian a temporary right to seek and provide healthcare and healthcare decisions on behalf of their child.
Authorization to Disclose Health Information Form
Authorization to Disclose Health Information Form An Authorization to Disclose Health Information is used when you desire to allow others to disclose information regarding your health. It spells out the specific information to be disclosed, who is authorized to do so, and the purposes for disclosure.
Ohio Durable Power of Attorney for Health Care
Ohio Durable Power of Attorney for Health Care Ohio Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
California Advance Health Care Directive
California Advance Health Care Directive This form can be used in the state of california, an Advance Directive provides a way for people to direct their own. healthcare even when they are in a coma, have dementia or are mentally. incapacitated or unable to communicate.
I-693 (2017)
I-693 (2017) Generally, all applicants filing for adjustment of status to that of a lawful permanent resident must submit Form I-693 completed by a designated civil surgeon. Form I-693 is used to report results of a medical examination to USCIS. The examination is req
Release of Accident Claims
Release of Accident Claims A Release of Accident Claims fully releases and permanently discharges a party from any future claims arising from a motor vehicle accident. It sets forth any sums paid in its consideration and that the party signing this does so voluntarily for settlement of all claims.
Texas Statutory Advance Medical Directive
Texas Statutory Advance Medical Directive Texas Advance Medical Directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions.
Rhode Island Statutory Form Durable Power of Attorney for Health Care
Rhode Island Statutory Form Durable Power of Attorney for Health Care Rhode Island Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Doctors Note
Doctors Note A Document that serves as an Excuse letter because you are unfit to work or to show evidence of health condition
New Jersey Proxy Directive
New Jersey Proxy Directive New Jersey Health Care Proxy is a document that names someone you trust as your proxy, or agent, to express and make health care decisions for you. They ensures you to get the health care you prefer in the event that you cannot communicate your wishes.
Delaware Advance Health-Care Directive
Delaware Advance Health-Care Directive This form may be used in the State of Delaware to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. by signing this form it gives all the rights.
Health Care Proxy
Health Care Proxy A health care proxy form is a legal document that is used to appoint another person to legally make decisions on behalf of the patient with regards to health care.
Traveler Health Declaration
Traveler Health Declaration A number of governments have issued quarantine measures for travellers.
Organ Donation Agreement by Living Donor
Organ Donation Agreement by Living Donor This Anatomical Gift by Living Donor is written notification that an individual wants to donate his or her organs upon death. This gift sets out the name of the donor, the specific organs to be donated and the donee.
CMS 40B English (2014-2017)
CMS 40B English (2014-2017) Medicare is managed by the Centers for Medicare and Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.
Medical Certificate
Medical Certificate Medical certificate is used to certify that someone is free of contagious diseases, drug addiction, mental illness, or other health issues.
Advance Health Directive
Advance Health Directive An advance health directive (AHD)—sometimes called a living will—is a formal way to give instructions about your future health care.
Texas Statutory Medical Power of Attorney
Texas Statutory Medical Power of Attorney Texas Medical Power of Attorney Effective at a Future Time gives the person you designate (Agent) broad powers to handle your property during your lifetime. These powers may only be used after a certification that you have become disabled, incapacitated, or incompetent.
T2201 (2017)
T2201 (2017) Form T2201, Disability Tax Credit Certificate, has two parts: Part A and Part B. Part A has to be filled out by the person with the disability (or a legal representative), and Part B has to be filled out by the medical practitioner. Both parts of the form
Authorization to Release PHI
Authorization to Release PHI Authorization for Release of Protected Health Information (PHI)
Consent to Drug Test
Consent to Drug Test This is a template used to create and fill-out an Employee Separation Form which is a document between a borrower and a lender containing details of the loan for record and tracking of payment.)
1095-A (2016)
1095-A (2016) Form 1095-A is an IRS form for individuals who enroll in a Qualified Health Plan (QHP) through the Health Insurance Marketplace.
New Mexico Optional Advance Health-Care Directive
New Mexico Optional Advance Health-Care Directive New Mexico Optional Health Care Directive gives an individual a right to give instructions about their own health care. They are also authorize to name someone else to make health care decisions in their place. This form is either or both of these things.
HIV Test Result Form
HIV Test Result Form A non-reactive (negative) test result means that no antibodies to HIV-1 have been detected. HIV antibodies may be absent during the “window period” of infection.
Authorization to Obtain Medical Records and Billing Information
Authorization to Obtain Medical Records and Billing Information The Authorization to Obtain Employment Information is given by a client to an attorney in order to obtain information regarding the former's employment.
Pennsylvania Durable Health Care Power of Attorney
Pennsylvania Durable Health Care Power of Attorney Pennsylvania Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
CMS-485
CMS-485 The completed form provides all the information required to deliver relevant treatment and medical care to the patient, outside of a specialized institution.
Medical History
Medical History A health record is a confidential collection of relevant information from the health history of a person, including all past and present medical problems, disorders, and procedures, with a focus on the particular incidents occurring during the current episode of care impact the patient.
Advance Health Care Directive Letter
Advance Health Care Directive Letter An advance health care directive letter (AHD)—sometimes called a living will—is a formal way to give instructions about your future health care.
New York Health Care Proxy
New York Health Care Proxy New York Health Care Proxy is a document that names someone you trust as your proxy, or agent, to express and make health care decisions for you. They ensures you to get the health care you prefer in the event that you cannot communicate your wishes.
Vermont Statutory Durable Power of Attorney for Health Care
Vermont Statutory Durable Power of Attorney for Health Care Vermont Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
CMS-1500
CMS-1500 An online cms-1500 filler.
DS-3072
DS-3072 REPATRIATION/EMERGENCY MEDICAL AND DIETARY ASSISTANCE LOAN APPLICATION
1095-A (2017)
1095-A (2017) Form 1095-A is an IRS form for individuals who enroll in a Qualified Health Plan (QHP) through the Health Insurance Marketplace.
Tennessee Durable Power of Attorney for Health Care
Tennessee Durable Power of Attorney for Health Care Tennessee Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
LS 202 (2012)
LS 202 (2012) This form is submitted by the employer to report an injury or occupational illness.
Blood Pressure Tracker
Blood Pressure Tracker Blood Pressure Tracker helps you record your blood pressure and heart rate. You can trace past records and easily share it with your doctors.
Pennsylvania Medical Directive
Pennsylvania Medical Directive Pennsylvania Medical Directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions.
CMS L564 (2016)
CMS L564 (2016) The Request for Employment Information form, CMS-L564E, requests information regarding group health coverage for Medicare applicants to use during Medicare’s special enrollment period.
Medical Release
Medical Release A medical release form is a document that gives healthcare professionals permission to share patient medical information with other parties.
Advance Health Care Directive
Advance Health Care Directive An Advance Health Care Directive assigns an individual(s) to act as your agent and decision-maker about your medical care. It sets forth the names, addresses, and telephone numbers of those who you grant the authority.
Personal Injury Release of Liability
Personal Injury Release of Liability This is a template used to create and fill-out a Personal Injury Release of Liability Form.
Sign Up Sheet
Sign Up Sheet Sign Up Sheet is a list of persons who are willing to participate on a certain event.
DA 5500 - Body Fat Content Worksheet
DA 5500 - Body Fat Content Worksheet DA Form 5500 is a United States Army form used to record the body fat of a male military member.
Excuse Letter
Excuse Letter Excuse letter is a written letter that explains to an employer, school or other entity as to why a person is unable to attend. The excuse may have been due to sickness or medical emergency.
1095-A (2018)
1095-A (2018) Health Insurance Marketplaces furnish Form 1095-A to IRS to report certain information about individuals who enroll in a qualified health plan through the Health Insurance Marketplace.
Virginia Advance Medical Directive
Virginia Advance Medical Directive Virginia Medical Directive assigns an individual(s) to act as your agent and decision-maker about your medical care. It sets forth the names, addresses, and telephone numbers of those who you grant the authority.
Minnesota Durable Power of Attorney for Health Care Decisions
Minnesota Durable Power of Attorney for Health Care Decisions Minnesota Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
Blood Sugar Tracker
Blood Sugar Tracker The blood sugar tracker can help you keep track of your diabetes medicines and any changes in dosage and timing that your doctor may tell you to make. It can also help you keep track of how much mealtime insulin you took and when you took it.

Health forms are documents used by healthcare professionals and individuals for health-related purposes, including declaration and tracking of health status and recording of medical history.

Some companies and other organizations use health forms to determine the eligibility of an individual for employment. Their decision is based on a healthcare professional's medical diagnosis for the individual seeking employment. Determining the health of job applicants enables employers to employ highly skilled and healthy applicants who can perform their duties. It also helps them determine the appropriate response for those they want to hire but have health problems.

Before donating blood, tissues, or organs, a potential donor must seek medical certification from a licensed physician or healthcare professional to know whether he or she is qualified or not. To document the medical diagnosis or certification, healthcare professionals use health forms. They serve as written evidence that donors may use to donate. There are also health forms that can be used to revoke or refuse organ donation, such as a Refusal to Donate Organs form.

While most health forms require the approval of healthcare professionals, there are health forms that do not, such as Health Declaration Form and Contact Tracing Form.

Health forms you may use

Contact Tracing Form

A Contact Tracing form is a document used to conduct contact tracing. It is an instrument designed to trace the transmission of Coronavirus disease or COVID-19. Contact Tracing is the identifying, listing, and following up of individuals who may have close contact with a confirmed, probable, and suspected COVID-19 case. It is a protocol that helps track down people who are possible carriers of the disease.

Health Declaration Form

A Health Declaration form is used in the entry and exit screening procedures in public transportations, establishments, and other entities. It is designed as one of the health protocols that help mitigate the spread of Coronavirus disease or COVID-19.

Traveler Health Declaration

If you plan to travel to the United States, furnish a Traveler Health Declaration form. It is a form used by the U.S. public health authorities and other international, federal, state, or local agencies to assess foreign travelers as a precautionary measure to prevent them from transporting COVID-19 to the U.S.

Doctor's Note

A Doctor's Note is a document issued by a doctor or medical professional that contains his or her patient's information, including the patient's medical condition and the number of days needed to rest. It also includes the doctor's medical diagnosis and medical advice or prescription for the patient. A Doctor's Note is needed when a student or an employee plans to file a leave of absence due to medical conditions.

Medical Certificate

A Medical Certificate is used to certify that a patient was examined and treated by a medical professional. It also certifies that a patient is free of contagious diseases, drug addiction, mental illness, or other health issues.

Fit to Work Certificate

A Fit tor Work Certificate is a document issued by a physician or medical professional to certify that an individual is fit or unfit to work or fit to work but subject to work modifications. Employees use it to testify that they have been treated for the illness or injury that prevents them from working. Some employers require their newly hired employees to furnish a Fit to Work Certificate as a pre-employment requirement. It is to identify whether the newly hired employees are fit and capable of handling tasks and responsibilities.

Child Medical Consent Form

A Child Medical Consent Form is a legal document that grants a non-parent or legal guardian the temporary rights to access medical care and give healthcare decisions for a child. It is essentially used during life-threatening situations or emergencies where a child needs immediate medical attention and his or her parents or legal guardians are unavailable. It ensures that a child's parents or legal guardians consent to the physician or medical professional to perform necessary medical procedures or operations. A Child Care Authorization Letter is another related document that works the same as a Child Medical Consent Form.

Medical Release Form

Healthcare professionals use a Medical Release form to ask an individual or patient's consent to disclose his or her medical information to a third party. The need to disclose a patient's information is when a third party like an insurance company asks for the patient's medical history. It is also needed if the patient's medical history or information will be used for marketing, fundraising, or research.

Advance Health Care Directive Form

An Advance Health Care Directive Form is a legal document used to record an individual's future health care decisions, including the directions, procedures, and precautions he or she opt for various medical conditions. His or her decisions listed on the Advance Health Care Directive Form may come into effect once he or she became physically or mentally unable to make decisions in the future.

Organ Donation Form

If you plan to donate your organs or tissues upon death, you may use an Organ Donation Form to document your consent. Your consent includes the specific organs or tissues you wish to donate and their recipients. You may also include other terms and conditions regarding your donation.

Refusal to Donate Organs Form

If you have signed a document to donate an organ but later changed your mind, use a Refusal to Donate Organs form to revoke the previous agreement. Although donating an organ is a selfless act, you have the right to refuse it. If you want to keep your organs after passing away, you may use a Refusal to Donate Organs form to inform your legal guardians or other bereaved loved ones about your wish.

Maternity Leave Letter of Intent

A Maternity Leave Letter of Intent is filed by an employee who needs time off work to give birth, recover, and take care of her newborn child. Employers are required under the Family and Medical Leave Act (FMLA) of 1993 to grant their pregnant employees a 12-week maternity leave.

Medical History Form

A Medical History form or Health History Record contains an individual's medical information, which a medical professional use to determine the best treatment or operation to conduct. It includes the individual's allergies, illnesses, past surgeries, vaccinations, and results of physical exams and tests.

Pet Care Agreement

Pet owners may use a Pet Care Agreement to hire caregivers for their pets. It is a form used to set forth the agreement between a pet owner and a pet sitter regarding pet health care and services. It outlines the pet's information, including the name, gender, health conditions, and medications.

Blood Sugar Tracker Form

Use a Blood Sugar Tracker form to track your diabetes medicines, including the changes in dosage or timing. It will help you measure your mealtime insulin consumption and record the time of intake.