Healthcare

About this category:

Medical documents are legally binding documents used to track a patient's health, obtain permission for medical procedures, outline wishes for medical care, appoint a representative, and certify death.

Templates in this category:

Advance Health-Care Directive (Hawaii)

This legal template likely provides a standardized form for individuals in Hawaii to outline their preferences and instructions for medical treatment and end-of-life care in the event they are unable to communicate their wishes. It ensures their autonomy and guarantees the lawful execution of their healthcare decisions under USA law.

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23
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3

COBRA Second Qualifying Event Notice

The legal template pertains to the COBRA (Consolidated Omnibus Budget Reconciliation Act) second qualifying event notice under USA law. It presumably provides guidance on the specific requirements and procedures that must be followed when informing eligible individuals of their right to continued health coverage after experiencing a second qualifying event.

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6
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18
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2

Summary Annual Report (SAR) For Health & Welfare Plans

This legal template could be a document outlining the key details and summary of a health and welfare plan's annual report, including information on plan participants' benefits, financials, and other relevant data.

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12
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19
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2

Medicare Advantage Addendum

This legal template is likely to provide an addendum for Medicare Advantage plans, which are private health insurance options available to Medicare beneficiaries in the United States. The addendum would likely outline additional terms, conditions, or amendments specific to these plans, ensuring compliance with the relevant laws and regulations in the USA.

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9
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11
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6

Declaration for Mental Health Treatment (Texas)

This legal template provides a declaration for individuals in Texas to express their preferences and decisions regarding mental health treatment, ensuring their rights and wishes are upheld in accordance with USA law.

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11
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8
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1

Certificate of Group Health Plan Coverage

This legal template could be a document certifying an individual's coverage under a group health plan in the United States, providing proof of their participation and enrollment in the plan.

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6
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25
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1

Statutory Simple Health Care Power of Attorney (North Carolina)

This legal template provides a simple and standardized document for residents of North Carolina to designate a trusted individual to make healthcare decisions on their behalf in case of incapacitation or inability to communicate.

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3
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5

Living Will (Illinois)

The Living Will (Illinois) legal template is a document that outlines an individual's healthcare preferences and treatment decisions in the event they become incapacitated and unable to communicate, ensuring their wishes are respected and honored.

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11
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22
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2

Directive to Physicians (Texas)

This legal template is likely a document that provides instructions to physicians in the state of Texas, USA, outlining specific medical decisions or preferences that an individual wants followed in the event they become incapacitated or unable to communicate their own medical decisions.

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19
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2

FMLA/CFRA Eligibility, Rights, and Responsibilities (California) Notice

This legal template provides a notice under USA law specifically for California employees regarding their eligibility, rights, and responsibilities concerning the Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA). It outlines the necessary information and guidelines that employees need to understand and comply with regarding these important employment laws.

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10
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1

Declaration for Mental Health Treatment (Illinois)

This legal template outlines the requirements and procedures for a Declaration for Mental Health Treatment in the state of Illinois, as mandated by United States law. It serves to formalize an individual's preferences and instructions regarding their mental health treatment in case they become incapacitated or unable to make decisions for themselves.

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17
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4

Health Care Contract Review & Approval Policy

This legal template likely outlines the process and guidelines for reviewing and approving health care contracts. It may include criteria for evaluating the contracts, required documentation, and the necessary steps for obtaining approval from key stakeholders.

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1
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4

Facility Medical Director Job Description (General)

This legal template outlines the job description for a Facility Medical Director position in the United States. It includes general duties, responsibilities, and qualifications required for the role.

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21
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5

Exchange Notice for Employers Who Do Not Offer a Health Plan

This legal template could be a notice provided by employers who are not offering a health plan to their employees in accordance with the laws of the United States. The notice could serve to inform employees about the available health insurance marketplace and potential coverage options they can explore independently.

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25
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6

Physician Employment Contract with Hospital or Health Care Organization

This legal template provides a comprehensive agreement between a physician and a hospital/healthcare organization, outlining the terms of employment, responsibilities, compensation, benefits, and other related clauses to ensure a mutually beneficial and legally binding relationship.

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9
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2

Medical Record Documentation Policy

This legal template provides guidelines and requirements for documenting medical records in accordance with USA law. It outlines the necessary documentation practices and procedures to ensure compliance and accuracy in maintaining patient records.

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26
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5

Hospital Financial Assistance Policy

This legal template could be a document outlining a hospital's policy on providing financial assistance to patients who are unable to pay their medical bills. It may include eligibility criteria, application process, and types of assistance available.

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12
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11
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5

Power of Attorney for Health Care Decisions (Washington)

This legal template is a document specific to the state of Washington that grants authority to a designated individual to make healthcare decisions on behalf of someone else, known as the principal, in the event they are unable to do so themselves.

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25
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4

Medical Staff Conflict of Interest Disclosure Statement

This legal template is a standardized form that medical staff members in the USA can use to disclose any conflicts of interest they may have. It helps ensure transparency and adherence to legal obligations in the healthcare industry.

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10
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2

Policy on Policies For Health Care Organizations

This legal template is a document that outlines the guidelines and procedures for creating and implementing policies within health care organizations. It provides clear instructions on drafting, reviewing, and updating policies to ensure compliance with legal and ethical standards.

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22
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2

Federal Sector Employee Request For Medical Exception to COVID-19 Vaccination Requirement

This legal template is designed for federal sector employees who want to request a medical exception to the COVID-19 vaccination requirement mandated under USA law. It provides a framework for employees to seek an exemption based on medical grounds in accordance with the relevant regulations and policies.

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14
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3
Contract sub-type

Request

Use this template

HIPAA Release (Pennsylvania)

This legal template could be about a HIPAA Release form specific to the state of Pennsylvania. It outlines the authorization for the disclosure of an individual's protected health information under the Health Insurance Portability and Accountability Act (HIPAA).

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21
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1
Contract sub-type

Release

Use this template

HIPAA Release (California)

This legal template is likely a form for obtaining a patient's authorization to disclose their protected health information under the Health Insurance Portability and Accountability Act (HIPAA) regulations in the state of California.

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23
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5
Contract sub-type

Release

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Policy on Purchases from Physician-Owned Distributors (PODs)

This legal template outlines a policy governing the procurement of medical supplies from companies owned by physicians. It aims to establish guidelines and protocols to ensure transparency, fairness, and compliance with legal and ethical standards when engaging with Physician-Owned Distributors (PODs).

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19
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4

HIPAA Hybrid Entity Policy

The legal template for the HIPAA Hybrid Entity Policy is a document that outlines the policies and procedures necessary for an organization to comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations as a hybrid entity. It provides guidelines for the handling of protected health information (PHI) and ensures the organization's compliance with HIPAA privacy and security rules.

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11
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2

Privacy Laws Representations & Warranties For Healthcare Companies

This legal template could be a document outlining the representations and warranties related to privacy laws that healthcare companies should adhere to. It could address confidentiality, data protection, HIPAA compliance, and other relevant privacy regulations.

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12
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6
Contract sub-type

HIPAA

Use this template

HIPAA Authorization to Use & Disclose Protected Health Information For Clinical Research

This legal template is designed to allow individuals to authorize the use and disclosure of their protected health information (PHI) for the purpose of clinical research in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

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14
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6
Contract sub-type

HIPAA

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Advance Directive for Health Care (Georgia)

This legal template is a document used in the state of Georgia, USA, to outline an individual's preferences and instructions regarding their medical care in the event they become unable to make decisions for themselves. It serves as a guide for healthcare providers and family members, ensuring the person's wishes are respected.

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6
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3

Health Care Directive (Washington)

This legal template is a document specific to Washington state that allows individuals to outline their preferences and instructions regarding their medical treatment and end-of-life care, ensuring their healthcare decisions are respected and followed in case they become incapacitated or unable to communicate.

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22
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4

HIPAA Privacy Practices for Group Health Plans Notice

This template provides a concise and informative notice, outlining the HIPAA privacy practices that apply to group health plans. It ensures that individuals are aware of their rights regarding the protection of their personal health information.

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6
Contract sub-type

Notice

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HIPAA Request For Accounting of Health Plan or Provider Disclosures

This legal template is likely a form that individuals can use to request an accounting of disclosures made by their health plan or healthcare provider under the Health Insurance Portability and Accountability Act (HIPAA). This allows individuals to track and monitor how their protected health information is being shared or disclosed.

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26
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6
Contract sub-type

Request

Use this template

HIPAA Release (Massachusetts)

This legal template is most likely a form that allows individuals in Massachusetts to authorize the release of their protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA). It is used to grant consent for healthcare providers to disclose personal medical records to specific individuals or organizations as required.

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8
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2
Contract sub-type

Release

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Health Care Exclusion List Screening Policy

This legal template likely outlines the procedures and guidelines for healthcare providers or organizations to screen individuals and ensure they are not on any exclusion list that would prohibit them from receiving healthcare benefits or services.

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17
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6

Certification of Health Care Provider for Employee's Pregnancy Disability (California)

This legal template is likely a form or document used in California to certify an employee's pregnancy disability. It is specifically designed for health care providers to confirm and provide necessary information about an employee's pregnancy-related condition in accordance with the laws and regulations of the United States.

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22
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4

HIPAA Special Enrollment Rights: Initial Notice

This legal template could be used to provide individuals with an initial notice about their special enrollment rights under the Health Insurance Portability and Accountability Act (HIPAA). It may outline the circumstances in which individuals may qualify for a special enrollment period to enroll in health insurance plans outside of the standard open enrollment period.

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12
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3
Contract sub-type

Notice

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Health Care Collaboration Contract with Non-Physician Practitioner

This legal template is a contract that establishes a collaboration agreement between a health care provider and a non-physician practitioner. It outlines the terms and conditions for their professional relationship, including roles, responsibilities, compensation, confidentiality, and duration of the collaboration.

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7
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5

Advance Directive for Health Care (New Jersey)

This legal template is a document specific to New Jersey, USA, that outlines an individual's preferences and instructions for their medical care in case they become unable to communicate or make decisions in the future. It typically covers end-of-life treatment, medical interventions, and appoints a healthcare representative.

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10
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3

Emergency Medical Care Policy (without Emergency Department)

This legal template outlines the policy for emergency medical care without emergency department services as per USA law. It provides guidelines, procedures, and responsibilities for healthcare providers and facilities to ensure prompt and appropriate emergency care in non-emergency department settings.

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26
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3

Health Care Directive (Minnesota)

This legal template provides individuals in Minnesota with a comprehensive Health Care Directive, allowing them to make informed decisions about their medical treatment preferences and appointing a trusted agent to ensure their wishes are followed in the event they are unable to communicate.

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16
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3

Advance Health Care Directive (New Hampshire)

This legal template pertains to an Advance Health Care Directive, specific to the state of New Hampshire in the United States. It outlines the individual's instructions regarding their medical treatment and end-of-life decisions, ensuring their healthcare preferences are respected when they are unable to express them.

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5
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2

Medicare Compliance Plan

This legal template provides guidance on creating a Medicare Compliance Plan as required by USA law. It covers the necessary steps, policies, and procedures to ensure adherence to Medicare regulations and prevent fraud and abuse.

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25
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3

Health Care Proxy (Massachusetts)

A Health Care Proxy (Massachusetts) is a legal document that allows an individual to appoint someone to make medical decisions on their behalf if they become incapacitated and unable to do so. This template provides a standardized form for individuals in Massachusetts to designate their chosen health care agent.

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10
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6

HIPAA Release (Florida)

This legal template provides a standardized form for individuals in Florida to authorize the release of their protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

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16
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4
Contract sub-type

Release

Use this template

Hospital Financial Assistance Policy Plain Language Summary

This legal template could be a simplified summary of the Hospital Financial Assistance Policy, aimed at providing clear and concise information to patients regarding the financial assistance programs available to them for medical care received at the hospital.

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8
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2

Power of Attorney for Health Care Decisions (Nebraska)

This legal template is a document specific to Nebraska that allows individuals to appoint a trusted person to make health care decisions on their behalf in case they become unable to do so themselves.

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25
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2

Availability of Health Plan's HIPAA Privacy Practices Notice

This legal template could be a document that outlines the requirements and procedures for healthcare providers to make their HIPAA Privacy Practices Notice available to individuals, as mandated by USA law. It may detail the various ways in which the notice can be disseminated and accessed by patients to ensure compliance with HIPAA regulations.

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17
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6

HIPAA Release

A HIPAA release is a legal template that authorizes healthcare providers to disclose an individual's protected health information to specified individuals or organizations, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations.

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13
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4
Contract sub-type

Release

Use this template

Procedures For Identifying Qualified Medical Child Support Orders

This legal template provides guidelines and procedures for accurately identifying and handling Qualified Medical Child Support Orders (QMCSOs) in compliance with applicable laws and regulations. It aims to ensure that child support arrangements involving healthcare coverage are correctly identified and implemented.

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Qualified Protective Order by HIPAA (Federal)

This legal template likely pertains to the Qualified Protective Order under the Health Insurance Portability and Accountability Act (HIPAA) in the United States. It may include guidelines and provisions for protecting sensitive healthcare information and ensuring its confidentiality and security.

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4
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2

HIPAA Release (Georgia)

This legal template could be a document used in Georgia to authorize the release of protected health information (PHI) under the regulations of the Health Insurance Portability and Accountability Act (HIPAA). It may outline the purpose, scope, and duration of information disclosure and provide necessary consent from the individual seeking access to their healthcare records.

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12
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1
Contract sub-type

Release

Use this template

Health Care Proxy (New York)

This legal template is likely a document specific to the state of New York that allows individuals to appoint a trusted person to make healthcare decisions on their behalf in case they become unable to do so.

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7
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5

Surprise Medical Billing For Providers & Facilities: Disclosure Notice

This legal template is designed to provide a disclosure notice to healthcare providers and facilities regarding surprise medical billing policies and practices, aiming to ensure transparency and protect the rights of patients.

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Advance Directive (Maryland)

This legal template is likely a document that outlines an individual's healthcare preferences and instructions for medical treatment in the state of Maryland, in accordance with USA law. It may cover topics such as life-sustaining interventions, end-of-life decisions, and appointed healthcare proxies.

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26
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Advance Health-Care Directive (Delaware)

This legal template pertains to an Advance Health-Care Directive specifically for the state of Delaware in the United States. It provides individuals with a legal document to outline their preferences and instructions regarding medical treatments and end-of-life care in the event they become unable to communicate or make decisions.

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Medical Power of Attorney (Texas)

This legal template outlines the appointment of a trusted individual in Texas, USA, to make medical decisions on behalf of the person granting the power of attorney.

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Health Care Vendor Disclosure Statement & Certification

This legal template is designed to outline the disclosure requirements and certification process for health care vendors in the industry. It ensures that vendors provide accurate information regarding their services, compliance with regulations, and any conflicts of interest.

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13
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6

HIPAA Release (Illinois)

This legal template is likely a form that allows individuals in Illinois to authorize the release of their protected health information under the Health Insurance Portability and Accountability Act (HIPAA). It ensures compliance with the privacy provisions of HIPAA when sharing health-related data with other parties.

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5
Contract sub-type

Release

Use this template

FMLA Certification of Health Care Provider For Family Member's Serious Health Condition

This legal template is a standardized form used to verify the serious health condition of a family member under the FMLA (Family and Medical Leave Act) in the United States. It is typically completed by a healthcare provider to certify the condition and support an employee's request for leave.

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19
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6

HIPAA Release (Texas)

This legal template could be about a HIPAA release form specific to the state of Texas. It would outline the authorization for the release of protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

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17
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1
Contract sub-type

Release

Use this template

HIPAA Business Associate Policy

This legal template is likely a document outlining the policy and guidelines for businesses or organizations that handle protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA). It likely addresses the responsibilities, obligations, and security measures that business associates must adhere to when handling PHI.

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HIPAA Request to Amend Protected Health Information

This legal template could be used to request an amendment to one's protected health information under the Health Insurance Portability and Accountability Act (HIPAA).

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Contract sub-type

Request

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HIPAA Authorization to Use & Disclose PHI

This legal template would likely be a document granting authorization for healthcare providers or related entities to use and disclose a patient's protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

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26
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4
Contract sub-type

HIPAA

Use this template

HIPAA Release (New Jersey)

This legal template could be about a document designed for patients in New Jersey to authorize the release of their protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).

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5
Contract sub-type

Release

Use this template

Medical Power of Attorney and Living Will (West Virginia)

This legal template pertains to creating a Medical Power of Attorney and Living Will document that complies with the laws of West Virginia in the United States. It enables individuals to outline their healthcare preferences and appoint a trusted person to make medical decisions on their behalf if they become incapacitated.

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6

Hospital Emergency Medical Care Policy (with Emergency Department)

This legal template provides guidelines for emergency medical care policies within hospitals, particularly focusing on the operation and management of emergency departments. It covers protocols, procedures, patient triage, physician responsibilities, and collaboration with other healthcare providers to ensure efficient and quality emergency care.

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16
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5

Advance Directive for Mental Health Care (New Jersey)

This legal template is designed to address the specific requirements of creating an Advance Directive for Mental Health Care in the state of New Jersey, in accordance with the laws of the United States of America. It provides individuals with the ability to outline their preferences and instructions regarding their future mental health treatment, to ensure their wishes are respected in the event they become unable to make decisions for themselves.

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Informed Consent Template For Expanded Access to an Investigational Drug

This legal template provides a standardized form for obtaining the informed consent of patients who wish to access an investigational drug that is not yet approved by the FDA, but available under expanded access programs in compliance with USA law.

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Advance Directive (Virginia)

This legal template pertains to an Advance Directive document to be used in the state of Virginia, in accordance with United States law. It likely addresses healthcare preferences, end-of-life decisions, and the appointment of a healthcare agent to make medical decisions on behalf of the individual.

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Certification of Health Care Provider of Serious Health Condition (California)

This legal template is a Certification of Health Care Provider of Serious Health Condition specific to California under USA law. It may be used by healthcare providers to certify the existence of a serious health condition for the purpose of granting medical leave or accommodations to employees.

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Patient Advocate Designation (Michigan)

This legal template is likely about a document that allows individuals in Michigan to designate a patient advocate who can make healthcare decisions on their behalf in case they become incapacitated or unable to communicate their own preferences.

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HIPAA Breach Notification Letter to Plan Participants & Other Individuals

This legal template provides a standardized form to notify individuals, including plan participants, about a breach of protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). It assists in complying with the legal requirement of notifying affected individuals and provides necessary information regarding the breach and steps to take for protection.

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HIPAA

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Advance Directive for Health Care (Alabama)

This legal template is a document that allows individuals in Alabama to outline their preferences regarding medical treatment and end-of-life care in the event they become unable to make their own decisions. It is created to comply with USA law and ensures that healthcare providers and loved ones are aware of the individual's wishes.

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HIPAA Privacy Practices Acknowledgment Form Notice

This legal template could be a form or notice that outlines the privacy practices and policies of a healthcare provider or organization in compliance with the Health Insurance Portability and Accountability Act (HIPAA). It is used to inform patients or clients of their rights regarding the privacy and security of their health information and to obtain their acknowledgment or consent in receiving these services.

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Contract sub-type

Notice

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HIPAA Release (New York)

This legal template is a HIPAA release form specific to the state of New York. It allows individuals to authorize the disclosure of their protected health information (PHI) to specified parties, ensuring compliance with HIPAA regulations.

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Release

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Advance Directive for Health Care (Tennessee)

This legal template is likely a document that outlines the wishes and instructions of an individual regarding their medical treatment and care in the event they become unable to communicate or make decisions. It adheres to the laws and regulations specific to the state of Tennessee in the United States.

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HIPAA Business Associate Contract

This legal template outlines the contractual obligations and responsibilities between a covered entity (such as a healthcare provider) and a business associate under the guidelines of the Health Insurance Portability and Accountability Act (HIPAA).

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Executive Committee Charter For Non-Profit Hospitals & Health Care Organizations

This legal template outlines the purpose, composition, responsibilities, and decision-making processes of the executive committee in non-profit hospitals and health care organizations in compliance with USA law.

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HIPAA Privacy Practices for Health Care Providers Notice

This legal template provides a summary of the Privacy Practices under the Health Insurance Portability and Accountability Act (HIPAA) for health care providers. It outlines how patient information is protected, disclosed, and their rights regarding their health information.

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Notice

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HIPAA Request For Access to Protected Health Information

This legal template is a document that individuals can use to request access to their protected health information under the Health Insurance Portability and Accountability Act (HIPAA). It ensures compliance with privacy regulations and allows patients to review and obtain copies of their medical records.

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Request

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Advance Health Care Directive (Utah)

This legal template pertains to the Advance Health Care Directive specific to the state of Utah, under the laws of the United States. It is designed to assist individuals in expressing their medical treatment preferences and appointing a trusted agent to make healthcare decisions on their behalf if they become unable to do so.

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HIPAA Data Use Contract (DUA)

This legal template could be a contract between two parties, such as a healthcare provider and a research institution, outlining the terms and conditions for sharing and using protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

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Advance Health-Care Directive (Mississippi)

This legal template provides a framework for creating an Advance Health-Care Directive specific to Mississippi, in accordance with USA law. It enables individuals to express their preferences regarding medical treatment and appoint a trusted person to make decisions on their behalf in case they become incapable of doing so.

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Health Care Power of Attorney (South Carolina)

A legal document that grants an individual the authority to make medical decisions on behalf of someone else in the event they are unable to do so themselves. Specifically customized for residents of South Carolina.

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Medicare Delegation Oversight Policy

This legal template provides a comprehensive policy framework for overseeing the delegation of Medicare tasks and responsibilities in compliance with US law. It outlines guidelines and protocols to ensure effective oversight, accountability, and adherence to regulatory standards within healthcare organizations.

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Declaration of Natural Death (Kansas)

The Declaration of Natural Death (Kansas) template is a legal document designed to allow individuals in the State of Kansas, USA, to express their wishes concerning end-of-life medical treatment and establish their desire for a natural death in the event of a terminal condition or irreversible coma.

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Power of Attorney for Health Care (Wisconsin)

This legal template aims to provide residents of Wisconsin with a document that grants a trusted individual the authority to make decisions regarding the individual's health care and medical treatment in the event they become incapable of making such decisions themselves.

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Advance Health Care Directive (California)

This legal template is a document specific to California residents, governing decisions regarding medical care and treatments in the event of incapacity or illness. It outlines an individual's wishes, appoints a healthcare agent, and complies with state laws to ensure these directives are followed.

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Code of Conduct For Hospitals & Hospital Systems

This legal template provides guidelines for hospitals and hospital systems in the United States, outlining the code of conduct they must adhere to. It addresses various ethical and legal aspects of their operations, ensuring compliance with relevant laws and regulations.

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Health Care Provider Professional Services Contract (Facility-friendly)

This legal template is a contract specifically designed for health care providers and facilities to outline the terms and conditions of professional services. It ensures a mutually beneficial relationship between the provider and the facility while protecting the rights and responsibilities of both parties involved.

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FMLA Certification For Serious Injury or Illness of Current Servicemember For Military Caregiver Leave

This legal template provides a certification form for employees requesting Military Caregiver Leave under the Family and Medical Leave Act (FMLA) in the United States. It is specifically designed for cases involving a serious injury or illness of a current servicemember.

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