The only approved forms at this time are the following:
• Credit Authorization Form approval #H02 18 12 4811-6111-8325.3
• Trifold Brochure #H01 18 11
• My Essentials Waiver Form #H04 18 12
These codes are found on the bottom right of each document that has been approved by your State Department of Insurance as well as My Essentials.
We ask that any document or marketing material that mentions My Essentials (other than those listed above) be removed from view and disposed of.
The only exception would be for “old” authorization forms that have been signed by the patient. These should be kept in the patient’s file in a secure location for at least 5 years.
If you need to order more forms please email: materials@myessentials.zendesk.com