Please see below for a list of helpful, downloadable forms.

Patient Handbook and Orientation

Agency Forms

Assignment of Benefits

Notice of Medicare Non-Coverage

Patient Authorization Form

Patient Consent Form

Patient Requested Travel Hold Harmless Agreement Template

Photo Release Authorization

Caregivers Forms

Bill Sheet

Timesheet

Emergency Management Forms

Dade Evacuation Assistance Application – Creole

Dade Evacuation Assistance Application – English

Dade Evacuation Assistance Application – Spanish

Emergency Checklists

Emergency Management Resources:

Broward County Emergency Management:
http://www.broward.org/hurricane/Pages/Default.aspx

Broward County Vulnerable Population Registration:
https://webapps4.broward.org/VulnerableRegistry/Welcome.aspx

Dade County Emergency Management:
http://www.miamidade.gov/fire/emergency-management.asp

Miami-Dade Evacuation Assistance Application Online:
http://gisweb.miamidade.gov/eeap/