PDF Forms and References in Alphabetical Order
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
- AAP Recommendations for the Preventive Pediatric Health Care (PDF)
- Adult AIDS/HIV Confidential Case Report (PDF)
- After-Hours Sample Script - Arabic (PDF)
- After-Hours Sample Script - Armenian (PDF)
- After-Hours Sample Script - Chinese (PDF)
- After-Hours Sample Script - English (PDF)
- After-Hours Sample Script - Farsi (PDF)
- After-Hours Sample Script - Hmong (PDF)
- After-Hours Sample Script - Khmer (Cambodian) (PDF)
- After-Hours Sample Script - Korean (PDF)
- After-Hours Sample Script - Russian (PDF)
- After-Hours Sample Script - Spanish (PDF)
- After-Hours Sample Script - Tagalog (PDF)
- After-Hours Sample Script - Vietnamese (PDF)
- Autoclave Log (PDF)
B
C
- Certification for Contracts Grants, loans, and Cooperative Agreements (PDF)
- Clinical Payment Policy CP.MP.152 - Measurement of Serum 1 25-dihydroxyvitamin D (PDF)
- Clinical Payment Policy CP.MP.153 - Helicobacter Pylori Serology Testing (PDF)
- Clinical Payment Policy CP.MP.154 - Thyroid Hormones and Insulin Testing in Pediatrics (PDF)
- Clinical Payment Policy, CCP.MP.155 - EEG in the Evaluation of Headache (PDF)
- Clinical Payment Policy CP.MP.156 - Cardiac Biomarker Testing for Acute Myocardial In farction (PDF)
- Clinical Payment Policy CP.MP.157 - 25-hydroxyvitamin D Testing in Children and Adolescents (PDF)
- Clinical Payment Policy CP.MP.38 - Ultrasound in Pregnancy (PDF)
- Confidential Morbidity Report (PDF)
D
E
F
G
H
I
- ICD-10-CM Codes for Abortion-Related Services (PDF)
- Identification card (Large group PureCare HSP) (PDF)
- Individual Family Plan member eligibility status displayed on the secure provider portal (PDF)
- Industry Collaboration Effort (ICE): Provider Tools to Care for Diverse Populations (PDF)
- Inpatient California Health Net Commercial Prior Authorization (PDF)
- Interpreter Service Quick Reference Card (PDF)
J
K
L
M
- Medical Record - Adult Health Maintenance Checklist With Standards (PDF)
- Medical Record - Advance Directive Labels (PDF)
- Medical Record - Audiometric Screening (PDF)
- Medical Record - History Spanish (PDF)
- Medical Record - Medication and Chronic Problem Summary (PDF)
- Medical Record - Signature Page (PDF)
- Medical/Behavioral Comanagement/Coordination of Care Form (PDF)
- Member Grievance Form (PDF)
N
O
P
- Palliative Care Providers (contracted)
- Physical or Speech Therapy (PDF)
- Potential Quality Issue Referral Form (PDF)
- Prescription Drug Prior Authorization or Step Therapy Exception Form (PDF)
- Provider Dispute Resolution Request - Commercial and Medi-Cal (PDF)
- Provider Dispute Resolution Request - IFP (PDF)