The 22 Alabama forms that ask for a clinician's input, from Medicaid prior authorization and school immunization certificates to sports physicals and parking placards.
This page lists the 22 Alabama forms that ask for a clinician's input, grouped by program. The ones you meet most are Medicaid's Form 342, the Prior Review and Authorization Request for non-pharmacy services, and Form 369 for pharmacy prior authorization. School-age patients need the Certificate of Immunization, printed from ImmPRINT, and the AHSAA Form 5 preparticipation physical for grades 7 to 12. The MVR 32-6-230 certifies limited walking for a disability parking placard or decal.
Only the revised 2018 AHSAA Form 5 is accepted, and it needs an M.D. or D.O. signature. Since 2016 the only approved immunization certificate is the one printed from ImmPRINT; certificates created by EHR vendors are not accepted. Medicaid wheelchair requests attach Form 384, the PT/OT seating evaluation, to the Form 342. The PT-PA-1 homestead affidavit must come from an Alabama-licensed physician actively treating the disability. All forms here are in English. Vero Documents fills PDF forms from the visit note and the chart, and you review and sign.
Applies for disability access placards or license plate decals, with medical certification that the applicant's walking is limited or impaired (permanent or temporary up to six months).
General Alabama Medicaid prior authorization request for medical care, surgery, DME purchase/rental, home health visits, PT/OT and other non-pharmacy services.
General pharmacy prior authorization request for non-preferred or PA-required drugs not covered by a drug-specific form.
Documents admission and medical evaluation data used to establish that a nursing facility resident meets Alabama Medicaid long-term care admission (level of care) criteria.
Form 362Referral from the screening/primary provider for EPSDT-identified services, case management/care coordination or other referred care.
Form 384Required attachment to Form 342 documenting the PT/OT seating and mobility evaluation for manual and power wheelchair requests.
Form 168Physician certification that a Medicaid recipient is terminally ill for Medicaid hospice benefit periods.
Physician's statement on file at the school certifying that a student in grades 7-12 passed a physical exam and is able to participate in interscholastic athletics (AHSAA Rule 1, Sec. 14).
Official certificate showing a child's school-required immunizations and expiration date, required on file for every child in Alabama schools and licensed child care.
ADPH-WIC-111aPrescription for an infant (birth-11 months) who is not fully breastfed and needs a formula other than the WIC contract formula, with qualifying diagnosis.
ADPH-WIC-111bPrescription required for children 12 months and older and women to receive any formula or WIC-eligible nutritional product.
Notifies WIC that a participant is being discharged from hospital on a special formula so WIC can issue it.
Portable medical order for seriously ill Alabamians recording CPR and treatment-intensity decisions; ADPH links the National POLST form.
Registered certifying physician diagnoses or confirms a qualifying condition and enters the patient's certification/recommendation in the state registry so the patient can obtain a medical cannabis card.
Ala. Admin. Code 540-X-25-.11 Appendix ARequired written informed consent the certifying physician personally obtains before certifying a patient for medical cannabis.
Online case report of an Alabama notifiable disease or condition (Immediate/Urgent and Standard notification), including STD and HIV cases.
DHR-FCS-1593Written follow-up by a mandated reporter of an oral report of suspected child abuse or neglect (Code of Alabama 26-14-3).
Report to Adult Protective Services of an adult suspected to be abused, neglected or exploited, with a mandated-reporter checkbox for physicians and practitioners of the healing arts.
Treating physician swears that a homeowner is permanently and totally disabled (and since when) for the Alabama H-3 total homestead exemption from state and county property tax.
Attending physician describes and certifies a voter's medical emergency (treatment within 5 days before an election) so the voter can obtain an emergency absentee ballot, delivered by mail or a designee.
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.
An M.D. or D.O. AHSAA Rule 1, Section 14 requires a physician's statement on file certifying that a student in grades 7 to 12 passed a physical exam and can take part in interscholastic athletics. The form has no NP or PA line, and only the revised 2018 Form 5 is accepted. The physician completes page 2: the exam, the clearance level (A, B or C) and the signature. The school keeps it in the superintendent's or principal's office.
Print it from ImmPRINT, the state immunization registry. A licensed physician's office or an ADPH county health department enrolled in ImmPRINT generates the certificate with the issuing site's name, address and date of issue. Since June 1, 2016 this is the only approved certificate, and certificates created by EHR vendors are not accepted. Pharmacies may print one only for children who are up to date. The parent gives it to the school or child care facility.
A licensed physician, certified registered nurse practitioner or certified nurse midwife completes the Requirements and Certification section of Form MVR 32-6-230, under penalty of perjury. One form covers permanent placards and temporary ones, which last up to six months with begin and end dates. The applicant returns it to the county licensing office. There is no fee for placards or decals, and people with permanent disabilities may self-certify at renewal.
No. Only an Alabama MD or DO who holds an ALBME Medical Cannabis Certification Permit and is registered with the AMCC can certify. The physician sees the patient in person, since telemedicine is not allowed, obtains the written informed consent in Appendix A of Ala. Admin. Code 540-X-25-.11, and enters the certification in the AMCC Patient Registry portal. Certifications last up to 90 days, or up to 30 days for patients capable of conception.