Third-party forms US clinicians complete for agencies, employers, insurers and schools, with who completes each one, its format and a link to the official page or PDF.
This library lists 2175 forms that US physicians, nurse practitioners, physician assistants and allied health professionals complete for third parties. The federal programs come first: FMLA certifications (WH-380-E and WH-380-F), the Social Security medical source statement (HA-1151), VA Disability Benefits Questionnaires and VA Form 21-2680, the DOT Medical Examination Report (MCSA-5875), Medicare's Home Health Certification and Plan of Care (CMS-485), and OWCP workers' comp reports such as the CA-17 and CA-20.
Each state adds its own: workers' comp reports, disability and paid leave claims such as California's DE 2501 and New York's DB-450, Medicaid prior authorizations, driver medicals, disability parking, school and sports physicals, immunization certificates and POLST forms. State hubs run from Alabama to Wyoming, plus DC and Puerto Rico, and national insurers' forms have a hub of their own. Spanish versions exist for 244 forms. Vero Documents fills PDF forms from the visit note and the chart, and the clinician reviews and signs.
The federal leave, disability and DOT forms, the big states’ workers’ comp and disability reports, and the prior authorization, parking and school forms almost every practice meets.
Certificado del proveedor de atención médica para la condición de salud grave de un empleado conforme a la Ley de Ausencia Familiar y Médica
Certifies the employee's own serious health condition, its onset, expected duration and the amount of FMLA leave (continuous, reduced schedule or intermittent) the employee needs.
Certificado del proveedor de atención médica para la condición de salud grave de un familiar conforme a la Ley de Ausencia Familiar y Médica
Certifies a family member's serious health condition and the care the employee needs to provide, supporting the employee's FMLA leave to care for that family member.
Records a medical source's opinion of a claimant's physical residual functional capacity (lifting, sitting, standing, manipulation, postural and environmental limits) for an SSDI/SSI hearing.
Records a medical source's opinion of a claimant's mental work-related abilities (understanding, interacting, concentrating, adapting) rated none to extreme, for an SSDI/SSI hearing.
Records a physical examination showing whether the Veteran, spouse, surviving spouse or parent is housebound or needs the regular aid and attendance of another person, for the A&A/Housebound add-on to compensation or pension.
Documents the Veteran's thoracolumbar spine conditions, including range of motion, radiculopathy and incapacitating episodes so VA can decide service connection and assign a disability rating.
Records the DOT physical qualification examination of an interstate commercial motor vehicle driver against 49 CFR 391.41 and the examiner's determination.
Certifies that an interstate CMV driver is physically qualified, with any conditions (corrective lenses, hearing aid, exemption, SPE certificate, intracity zone) and an expiration date.
Certifies a Medicare patient's homebound status and need for skilled home health care and sets out the plan of care (orders, diagnoses, goals) for the certification period.
Aviso anticipado de no cobertura para el beneficiario (ABN)
Warns an Original Medicare patient before a service that Medicare may not pay, so the patient can choose to receive it and accept financial liability.
Asks a Medicare Part D plan to cover a drug (prior authorization, formulary, step-therapy, quantity-limit or tiering exception), with a prescriber supporting statement.
Documents the immigration medical exam (communicable diseases, physical/mental disorders with harmful behavior, drug abuse, vaccinations) required for adjustment of status to permanent residence.
Solicitud de beneficios del Seguro por Incapacidad (DI)
Certifies that the claimant is unable to do regular or customary work because of illness, injury, pregnancy or surgery, with diagnosis, ICD codes and expected return-to-work date, to establish a California State Disability Insurance (DI) claim.
Notificación y prueba de reclamo por beneficios por discapacidad
Documents diagnosis, symptoms, objective findings, hospitalization and the period the claimant is unable to work for New York statutory short-term disability benefits (DBL).
Certificado de Proveedor de Atención Médica para el Cuidado de un Miembro de la Familia con un Problema de Salud Grave
Certifies that the employee's family member has a serious health condition and needs the employee's care, with the expected duration and frequency, for New York Paid Family Leave.
Initial physician report of every occupational injury or illness: history, findings, ICD-10 diagnoses, treatment and work status.
DWC Form PR-2Periodic or event-driven progress report from the primary treating physician on findings, diagnoses, treatment plan and work status.
Reporte de Estado de Trabajo
Reports whether the injured employee can return to work without restrictions, with listed activity restrictions, or not at all, and the expected dates.
Reports work-relatedness, major contributing cause, diagnosis, treatment plan and authorization requests, functional limitations/restrictions, and MMI/permanent impairment rating for an injured worker.
CA-17Informe de estado de servicio
Reports an injured federal employee's work restrictions and ability to return to regular or modified duty after an injury.
Standardized fax/mail prior authorization request for health care services that issuers, including Texas Medicaid and CHIP managed care organizations, must accept.
Uniform form a prescriber uses to request prior authorization or a step-therapy exception for a prescription drug from a California health plan, insurer or medical group.
CVS Caremark's general (global) request for prior authorization or formulary exception for commercial (non-Medicare) prescription benefit plans.
Documents diagnosis, pregnancy dates, treatment, restrictions/limitations and expected return-to-work date so Unum can decide a group short term disability claim.
Prescribed no-fault claim form on which a treating physician or other non-hospital provider verifies diagnosis, causation, disability (unable-to-work dates), future treatment and services rendered so the auto insurer can pay basic economic loss benefits.
Applies for a permanent, temporary or travel disabled person (DP) parking placard or DP license plates, with the medical provider's certification of the qualifying disability.
Licensed medical professional certifies a permanent or temporary disability (Transportation Code 681.001: mobility or vision) for a disability placard and/or license plates.
Records the clinician's preparticipation physical exam of an athlete (vitals, vision, cardiac, MSK and functional exam) as the basis for sports clearance.
Plan de manejo médico de la diabetes
School diabetes orders: supervision level, glucose monitoring/CGM, insulin delivery and dosing, low/high glucose management, glucagon, disaster and field-trip plans.
Portable medical order documenting CPR/DNR, intubation (DNI) and other life-sustaining treatment decisions that all providers must follow across care settings; the only authorized NY form for a nonhospital DNI order.
Each program page lists every form we confirmed for it, grouped by state or by who issues it.
Every form a state issues in one place, with links to the federal forms that apply everywhere.
Upload any fillable PDF and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Each form you upload becomes a template your whole clinic can use. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Third-party forms that US clinicians complete. Federal programs include FMLA, Social Security disability, VA and TRICARE, DOT and Coast Guard medicals, FAA medical certification, Medicare and OWCP workers' comp. State forms cover workers' comp, disability and paid leave, Medicaid and prior authorization, driver medicals, disability parking, school, sports and immunization forms, POLST, public health reporting, commitment and guardianship, and medical cannabis. Insurance companies' claim forms are listed too.
Yes. Spanish versions exist for 244 forms in the library. They include the FMLA certifications (WH-380-E and WH-380-F), the federal workers' comp Duty Status Report (CA-17) and Attending Physician's Report (CA-20), California's disability insurance claim (DE 2501), New York's DB-450 and the Texas Work Status Report (DWC073). The DB-450 also comes in several other languages.
They have no public blank form. The agency, employer or insurer issues them for a specific patient or claim, or the program asks for a report without a prescribed form. For example, the employing agency issues the federal CA-16 for each injury, Social Security hearing offices or the claimant's representative send the HA-1151 per case, and Ohio's permanent total disability claim needs a physician's narrative report rather than a set form. Those rows link to the official page that explains them.
Vero Documents fills PDF forms from the visit note and the patient's chart, and the clinician reviews the result and signs it. Upload any fillable PDF, including one you download from an official link here, and it becomes a template the whole clinic can use. Download, print or email the finished form, with the patient's consent.