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 624 State Forms found

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Limited Release of Health Information (HIPAA) (Arabic)

 C-3.3 (12-09)

Limited Release of Health Information (HIPAA) - English - French

 C-3.3 (12-09)

Limited Release of Health Information (HIPAA) - English - Urdu

 C-3.3 (12-09)

Medical Narrative Report Template for CMS-1500

 No Form Number 7/22

WAIVER AGREEMENT - Section 32 WCL (Bengali)

 C-32-B (4-21)

WAIVER AGREEMENT - Section 32 WCL (Yiddish)

 C-32-Y (4-21)

WAIVER AGREEMENT - Section 32 WCL (Arabic)

 C-32-A (4-21)

WAIVER AGREEMENT - Section 32 WCL (French)

 C-32 (4-21)

WAIVER AGREEMENT - Section 32 WCL (Urdu)

 C-32-U (4-21)

SECTION 32 WAIVER AGREEMENT: CLAIMANT RELEASE (Bengali)

 C-32.1B (4-24)

SECTION 32 WAIVER AGREEMENT: CLAIMANT RELEASE (Yiddish)

 C-32.1Y (4-24)

SECTION 32 WAIVER AGREEMENT: CLAIMANT RELEASE (Arabic)

 C-32.1A (4-24)

SECTION 32 WAIVER AGREEMENT: CLAIMANT RELEASE (French)

 C-32.1F (4-24)

SECTION 32 WAIVER AGREEMENT: CLAIMANT RELEASE (Urdu)

 C-32.1U (4-24)

Carrier's/Self-Insured Employer's Affirmation

 C-32AF (1-24)
Disclaimer: These forms may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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