Professional Licensing Agency Forms and Office Locations – Government Agency in Indiana

121 - 140 of 206 forms

Form Title	Topics
Medicaid Hospice Plan of Care Form
Medicaid Hospice Revocation Form
Medicaid Second Opinion Form
Medicaid Third-Party Liability Accident/Injury Questionnaire
Medicaid Third-Party Liability Questionnaire
Medical Clearance and Audiometric Test Form (the medical clearance form for hearing aids)
Medical Clearance Form for Hospital and Specialty Beds
Medical Clearance Form for Motorized Wheelchair Purchase
Medical Clearance Form for Negative Pressure Wound Therapy
Medical Clearance Form for Nonmotorized Wheelchair Purchase
Medical Clearance Form for Standing Equipment
Medical Clearance Form for TENS (Transcutaneous Electrical Nerve Stimulator) Unit
Member Petition for Administrative Review - Step 1
Member Petition for Administrative Review - Step 1
Notice of 340B Program Cancellation Form for IHCP Managed Care Outpatient Drug Claims
Notice of 340B Program Participation Form for IHCP Managed Care Outpatient Drug Claims
Nursing Home Fax Procedures to Obtain Medicare Prescription Drug Plan Enrollment Information for Multiple Residents
OA-01 Summary of Application and Existing Agreements
OA-02 Industrial / Commercial Surface Coating Operations -OR- Graphic Arts Operations (326 IAC 2-9-2.5)
OA-03 Surface Coating or Graphic Arts Operations (326 IAC 2-9-3)

Professional Licensing Agency