Document Archive

For your convenience, below is a list of Forms, Instructions and Publications in a PDF format, which can be viewed and saved using Adobe Reader software. To view, download or print one of these documents, simply click the image or button below.

Health Provider’s Request
for Decision On Unpaid
Medical Bill(s) (HP-1)

Health Provider's Request for Decision On Unpaid Medical Bill(s) (HP-1)

Attending Doctor’s Request for
Approval of Variance and Insurer’s
Response (MG-2)

Attending Doctor's Request for Approval of Variance and Insurer's Response (MG-2)

Request for Taxpayer
Identification Number and
Certification (W-9)

Request for Taxpayer Identification Number and Certification (W-9)