Official Healthcare Forms
Official-source healthcare, Medicare, benefits, authorization, claim, provider, and patient forms from government agencies.
Use current official-source forms
These pages prioritize forms with government or issuing-authority sources, source links, PDF workflows, and clear filing context. Always confirm final filing rules, fees, and submission channels with the official source.
Before filing
- Confirm the health program, beneficiary, provider, authorization, or claim context.
- Check privacy, identity, medical evidence, and signature requirements before submission.
- Use the issuing agency source page for current filing instructions and supporting documents.
342 Healthcare Forms
Page 7 of 15
Form CMS-10455(2018)
Report of a Hospital Death Associated with Restraint or Seclusion
Official Centers for Medicare & Medicaid Services CMS-10455 for Report of a Hospital Death Associated with Restraint or Seclusion, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS-10797(2025)
Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)
Official Centers for Medicare & Medicaid Services CMS-10797 for Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances), sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS-R-0235 D1(2009)
DSH Data Use Agreement for Cost Reporting Periods Prior to those that include December 8, 2004
Official Centers for Medicare & Medicaid Services CMS-R-0235 D1 for DSH Data Use Agreement for Cost Reporting Periods Prior to those that include December 8, 2004, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
Form CMS-R-0235 D2(2009)
DSH Data Use Agreement for Cost Reporting Periods that Include December 8, 2004 and therafter
Official Centers for Medicare & Medicaid Services CMS-R-0235 D2 for DSH Data Use Agreement for Cost Reporting Periods that Include December 8, 2004 and therafter, sourced from the CMS forms list and official PDF download catalog for Medicare, Medicaid, provider, plan, coverage, and beneficiary workflows.
GSA 12002(2026)
Fire protection, safety, and health programs: high risk use permit form
Official General Services Administration GSA 12002 form for Fire protection, safety, and health programs: high risk use permit form. This federal form supports healthcare workflows and is sourced from the GSA forms library.
GSA 19M(2026)
Request for a Medical Exception to the COVID-19 Vaccination Requirement
Official General Services Administration GSA 19M form for Request for a Medical Exception to the COVID-19 Vaccination Requirement. This federal form supports healthcare workflows and is sourced from the GSA forms library.
GSA 3559B(2026)
Follow-up Status Report for Facility Safety, Health or Fire Protection Survey
Official General Services Administration GSA 3559B form for Follow-up Status Report for Facility Safety, Health or Fire Protection Survey. This federal form supports healthcare workflows and is sourced from the GSA forms library.
GSA 3592(2026)
GSA Employee Report of Unsafe or Unhealthy Working Conditions
Official General Services Administration GSA 3592 form for GSA Employee Report of Unsafe or Unhealthy Working Conditions. This federal form supports healthcare workflows and is sourced from the GSA forms library.
Marketplace Application Instructions(2026)
Instructions for Application for Health Coverage and Help Paying Costs
Official HealthCare.gov instructions for the Marketplace paper health coverage application.
Marketplace Extra Person Pages(2026)
Extra Person Pages for Marketplace Health Coverage Application
Official HealthCare.gov extra person pages for larger household Marketplace paper applications.
Marketplace Health Coverage Application(2026)
Application for Health Coverage and Help Paying Costs
Official HealthCare.gov paper application for Marketplace health coverage and financial help.
New York DOH-5032(2026)
Authorization for Release of Health Information Pursuant to HIPAA
Official New York State HIPAA authorization form for release of health information.
OF 380(2026)
Reporting and Processing Medical Material Complaints/Quality Improvement Report
Official General Services Administration OF 380 form for Reporting and Processing Medical Material Complaints/Quality Improvement Report. This federal form supports healthcare workflows and is sourced from the GSA forms library.
OF 517(2026)
Medical Record - Anesthesia
Official General Services Administration OF 517 form for Medical Record - Anesthesia. This federal form supports healthcare workflows and is sourced from the GSA forms library.
OF 520(2026)
Electrocardiographic Record
Official General Services Administration OF 520 form for Electrocardiographic Record. This federal form supports healthcare workflows and is sourced from the GSA forms library.
OF 522(2026)
Medical Record - Request for Administration of Anesthesia and Performance of Operations and Other Procedures
Official General Services Administration OF 522 form for Medical Record - Request for Administration of Anesthesia and Performance of Operations and Other Procedures. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 2809(2026)
Health Benefits Election Form
Official General Services Administration SF 2809 form for Health Benefits Election Form. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 2810(2026)
Notice of Change in Health Benefits Enrollment
Official General Services Administration SF 2810 form for Notice of Change in Health Benefits Enrollment. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 2812(2026)
Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement
Official General Services Administration SF 2812 form for Report of Withholdings and Contributions for Health Benefits, Life Insurance, and Retirement. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 2812A(2026)
Report of Withholdings and Contributions for Health Benefits by Enrollment Code
Official General Services Administration SF 2812A form for Report of Withholdings and Contributions for Health Benefits by Enrollment Code. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 502(2026)
Medical Record - Narrative Summary (Clinical Resume)
Official General Services Administration SF 502 form for Medical Record - Narrative Summary (Clinical Resume). This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 503(2026)
Medical Record - Autopsy Protocol
Official General Services Administration SF 503 form for Medical Record - Autopsy Protocol. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 504(2026)
Medical Record - History - Part 1
Official General Services Administration SF 504 form for Medical Record - History - Part 1. This federal form supports healthcare workflows and is sourced from the GSA forms library.
SF 505(2026)
Medical Record - History - Parts 2 and 3
Official General Services Administration SF 505 form for Medical Record - History - Parts 2 and 3. This federal form supports healthcare workflows and is sourced from the GSA forms library.