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Useful forms American Academy of Family Physicians

>> Health Plan Complaint Form

Centers for Disease Control: National Immunization Program

>> Vaccine information sheets

Texas Department of Aging and Disability Services

>> Medical Power of Attorney | English

>> Medical Power of Attorney | Spanish

>> Standard DNR Form | English

>> Advanced Directive/Living Will | English

>> Advanced Directive/Living Will | Spanish

>> Consent to Medical Treatment | English

>> Consent to Medical Treatment | Spanish

Texas Health and Human Services Commission

>> Women’s Health Program Medicaid Application

Texas Department of Insurance

>> Professional Liability Insurance Carriers in Texas

Texas Department of State Health Services

>> Disease Reporting/Notifiable Conditions

Texas Department of Public Safety

>> Medical Examination for Commercial Driver Fitness Determination

Texas Medical Board

>> Change of Address Form

U.S. Department of Labor

>> Family and Medical Leave Act Certification of Health Care Provider Form

More useful forms

Power Mobility Devices

Because family physicians prescribe most power mobility devices, but rarely more than two or three annually, your Academy has developed a clinical guide for evaluating a patient for a power mobility device. The purpose of the guide is to assist the treating physician and assure conformance with Medicare’s extensive documentation requirements and face-to-face examination.

This guide is not a Medicare-approved form. Before using the form, physicians are encouraged to review the DME MAC physician guidance letter, which provides a synopsis detailing the highlights of documentation requirements.

>> Mobility Evaluation Guide