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Medical forms cover a broad spectrum of documentation needs — from requesting FMLA leave and filing workers' compensation claims to applying for Medicare, supporting VA disability benefits, and obtaining prior authorization for healthcare services. These forms serve as the official record between patients, providers, insurers, employers, and government agencies,

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About medical forms

The people who need these forms are equally varied: employees managing a serious health condition, veterans pursuing disability compensation, caregivers applying for support allowances, healthcare providers completing credentialing applications, and insurers processing claims. Whether you're a patient filling out a physician's statement of disability, a clinician completing a VA Disability Benefits Questionnaire, or an employer documenting FMLA eligibility, the stakes are high and the paperwork can be time-consuming and confusing.

This collection includes 53 forms spanning FMLA certifications, SSA disability reviews, VA DBQs, insurance claim packets, long-term care assessments, and more. Tools like Instafill.ai use AI to help you fill out these forms accurately in under 30 seconds, reducing the risk of errors and saving significant time — whether you're handling a single form or managing multiple submissions.

Forms in This Category

Form Name Pages
1. Form WH-380-E, Certification of Health Care Provider 4
2. Form OWCP-915, Claim for Medical Reimbursement 3
3. Form CMS-4040, Request for Enrollment in Medicare Part B 3
4. Form LS-275, Agreement and Undertaking 2
5. Form WH-385-V, Certification for Serious Injury or Illness 4
6. Form SSA-827, Authorization to Disclose Information 2
7. Form WH-381, Notice of Eligibility 4
8. Form WH-382, Designation Notice 2
9. Form CA-20, Attending Physician's Report 4
10. Form 8994, Employer Credit for Paid Family and Medical Leave 1
11. Form SSA-454-BK, Continuing Disability Review 12
12. Form 1099-SA, Distributions from HSA/MSA 5
13. Form OF-178, Certificate of Medical Examination 7
14. Form N-648, Medical Certification for Disability Exceptions 5
15. Form SHA, Separation Health Assessment 16
16. Form DBQ, Artery and Vein Conditions 10
17. Form DBQ, Heart Conditions Disability Benefits 10
18. Form DBQ, Hypertension Disability Benefits 4
19. Form DBQ, Diabetes Mellitus Disability Benefits 6
20. Form DBQ, Diabetes Mellitus Disability Benefits Questionnaire 6
21. Form DBQ, Thyroid and Parathyroid Conditions 10
22. Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire 13
23. U.S. Coast Guard Form CG-719K, Application for Medical Certificate 10
24. Form WH-380-E, Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act 4
25. Ankle Conditions Disability Benefits Questionnaire 14
26. Center for Infertility & Reproductive Surgery – New Patient Questionnaire and Patient/Guarantor Statement (Brigham and Women’s Hospital, Department of Obstetrics and Gynecology) 4
27. Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire 14
28. Elbow and Forearm Conditions Disability Benefits Questionnaire 15
29. Foot Conditions, Including Flatfoot (Pes Planus) Disability Benefits Questionnaire 16
30. Hip and Thigh Conditions Disability Benefits Questionnaire 13
31. Knee and Lower Leg Disability Benefits Questionnaire 15
32. Neck (Cervical Spine) Conditions Disability Benefits Questionnaire 14
33. Shoulder and Arm Conditions Disability Benefits Questionnaire 14
34. The Department of Medical Assistance Services Applied Behavior Analysis Preservice Service Authorization Request Form (Effective Dates of Service 09/01/2025 and after) 8
35. State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602) 2
36. Application for Scope of Clinical Practice (SoCP) – Application Form SoCP Only (v1.00 06/2014) 12
37. Continental American Insurance Company (CAIC) / Aflac Group Critical Illness Claim Form (with Attending Physician’s Statement, HIPAA Authorization to Obtain Information, and Electronic Funds Transaction Authorization) 8
38. SC ISP-2519, Medical Report for Canada Pension Plan Disability Benefits 15
39. Form SSA-454-BK, Continuing Disability Review Report 12
40. Function Report – Adult – Third Party (Form SSA-3380-BK) 10
41. Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years 13
42. SC ISP-2519, Medical Report for Canada Pension Plan Disability Benefits 15
43. Form SSA-454-BK, Continuing Disability Review Report 12
44. Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire 14
45. Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire 14
46. Assurity Life Insurance Company Disability Claim Form — Attending Physician’s Statement 3
47. Health Assessment – Ontario Health atHome (Fixing Long-Term Care Act, 2021) (Form 4768-69E) 7
48. Income Protection Claim Form (AIA New Zealand) 6
49. Medically Prescribed Treatment (Non-Medication) Form — Provider Treatment Order Form | Office of School Health | School Year 2025–2026 2
50. Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E 7
51. Form 3111E (2018/12), Ontario Works / Ontario Disability Support Program (ODSP) Application for Special Diet Allowance 5
52. Physician’s Statement of Disability / Functional Limitations (ICD Diagnosis Codes, Treatment, ADLs, and Return-to-Work) 2
53. HDFC ERGO General Insurance Company Limited – Request for Cashless Hospitalisation for Health Insurance (Policy Part – C) 2
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