Forms
Healthcare forms: what they are and how to fill them out
Claim, Medicare, enrollment, leave, privacy, and advance care forms, each linked to the government copy. Links checked October 23, 2026.
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14 healthcare forms explained field by field, with a link to each government PDF or rule, plus 40 state advance directive forms. Rivvi links forms; it does not host or change them.
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Most searched forms
| Form | What it is for | Type |
|---|---|---|
| FMLA forms (WH-380-E and WH-380-F) | The DOL's optional FMLA medical certification forms: WH-380-E for the employee's own condition and WH-380-F for a family member's | Leave |
| Advance directive form by state | An advance directive records your health care wishes and can name a health care agent | Advance care |
| ABN form (Advance Beneficiary Notice of Non-coverage, CMS-R-131) | The ABN (CMS-R-131) tells a Medicare patient before a service that Medicare may not pay and they may owe | Medicare |
| Medical power of attorney form | A medical (health care) power of attorney names the person who decides about your care if you cannot | Advance care |
| CMS-1500 form (HCFA 1500 claim form) | The CMS-1500 (02/12) is the paper claim for professional services | Claims |
| CMS-855I form (Medicare enrollment for physicians and practitioners) | The CMS-855I enrolls physicians and non-physician practitioners in Medicare and handles reassignment | Enrollment |
| HIPAA authorization form | What a valid HIPAA authorization must contain under 45 CFR 164.508, with a sample template | Privacy |
| UB-04 claim form (CMS-1450) | The UB-04 (CMS-1450) is the paper claim hospitals and facilities use | Claims |
| CMS-855B form (Medicare enrollment for clinics, groups, and suppliers) | The CMS-855B enrolls clinics, group practices, and certain suppliers in Medicare | Enrollment |
| WH-380-E form (FMLA certification for an employee's serious health condition) | WH-380-E is the DOL form a health care provider fills out when an employee asks for FMLA leave for their own condition | Leave |
| WH-380-F form (FMLA certification for a family member's serious health condition) | WH-380-F is the DOL form for FMLA leave to care for a family member | Leave |
| CMS-1696 form (Medicare appointment of representative) | The CMS-1696 lets a Medicare patient or provider name a representative for a claim, appeal, grievance, or request | Medicare |
| Release of information form (medical records request) | A release of information request is either a patient's right of access (45 CFR 164.524, 30 days) or an authorization to send records to someone else. | Privacy |
| POLST form (Portable Medical Orders) | A POLST turns a seriously ill person's wishes into medical orders that travel with them | Advance care |
Advance directive forms by state
- Alabama
- Arizona
- California
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Minnesota
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New York
- North Carolina
- North Dakota
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin