Health Care Authority, Washington State Forms and Office Locations – Government Agency in Washington

41 - 60 of 135 forms

Form Title	Topics
Enrollment and supplemental billing guide for new employers joining SEBB
exhibit-a-bidder-forms-and-certifications.
Exondys 51 request form
Extended Dependent Certification form
First working day of the month/effective date of coverage table
FSA and DCAP Claim form
FSA Termination form
HCA Support user guide
HCA Support user guide
Health Home participation form
Health Home participation form
Home Health Agency Attestation Form
Hospital bed evaluation form
Hysterectomy consent and patient information form
Initial notice of COBRA and Continuation Coverage rights
Initial notice of COBRA and Continuation Coverage rights
Institutions of higher education
Intent to Participate form - for carceral facilities participating in the Reentry Initiative
IV Iron request form
Life and AD&D administration manual

Health Care Authority, Washington State