Employer Forms
Providing your employees high-quality care and helping you maximize efficiency
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Employer Forms
Below you will a list of all available employer forms. If you have any questions, please contact us here.
Audiogram Questionnaire
Required for employees who require an audiogram
Authorization to Disclose Protected Health Information to Employer
Employee release to Employer
DOT Long Form (MCSA 5875)
Driver history and physical
DOT Medical Examiner Certificate (MCSA 5876)
Driver medical examiner certificate
Respirator Questionnaire (English)
Required annually for employees wearing tight fitting respirators. Recommended for those who wear loose fitting respirators.
Respirator Questionnaire (Spanish)
Required annually for employees wearing tight fitting respirators. Recommended for those who wear loose fitting respirators.
Service Authorization
Required for all employer services