Forms and supplies
If you need Covered Service cards or brochures, please call our Provider Support Line at 1-888-388-8782.
Downloads
PDF files require Acrobat Reader
Provider forms
- 2006 Eligibility Resource guide (PDF)
DOWNLOAD PDF - 2006 Income Eligibility card (PDF)
DOWNLOAD PDF - Breast & Cervical Health Program Screening form (PDF)
DOWNLOAD PDF - Enrollment & Consent form - 2006 (PDF)
DOWNLOAD PDF - NCEP ATP III guidelines (PDF)
DOWNLOAD PDF - SEARHC Patient Registration worksheet
DOWNLOAD PDF - WISEWOMAN Health History form (PDF)
DOWNLOAD PDF - WISEWOMAN Lifestyle questionnaire
DOWNLOAD PDF - Women's Health Covered Services (PDF)
DOWNLOAD PDF
Additional forms are available via fax; please call our Provider Support Line at 1-888-388-8782.
- ICD-9
- CPT Codes and Schedule of Fees
- SEARHC Health Visit voucher
Patient fact sheets
- Blood pressure fact sheet
DOWNLOAD PDF - HPV vaccine questions and answers
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* PDF files require Acrobat Reader
Copyright © 2010, SEARHC
SouthEast Alaska Regional Health Consortium
WISEWOMAN and BCHP