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Sample Program Documents

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posted: 02/07/2011

This document, intended for a hospital setting, provides a sample job description, list of justifications for creating the position and a projection of budget savings from creation of the position.

posted: 02/11/2009

Example of letter certifying patient’s need.

posted: 02/11/2009

PAP Information and Signature Authorization Form

posted: 02/11/2009

Patient Consent and Release for Exchange of Information

posted: 02/11/2009

Example appeal letter without Medicare Part D

posted: 02/11/2009

Example appeal letter with Medicare Part D.

posted: 02/11/2009

Example of Letter to appeal program decision.

posted: 02/11/2009

Self Declaration of Income letter.

posted: 02/11/2009

Example of Zero Income Attestation (no income letter).

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