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Forms Completion Without an Appointment
MeritCare Internal Medicine and Family Medicine in Fargo-Moorhead charge $20 for completion of forms outside of appointments. Patients are encouraged to bring all forms needing completion to their appointments.
Patients must have been seen by the physician within the past 12 months in order to complete a form/letter request. In some instances an appointment may be required to obtain the necessary information to complete the form.
There is NO CHARGE for the following forms:
- Forms that are brought to the provider appointment (except FAA physicals and DOT exams which will continue with the current process and fees).
- Printed copy of the patient’s immunization records.
- Medication Pre-Authorization requests.
- North Dakota/Minnesota Handicap parking requests.
- School excuses, work excuse and jury duty.
- School care plans for pediatric patients.
- Printed copy of medication list to attach to school authorization forms.
- Durable Medical Equipment forms.
- Home Care Orders / Authorizations.
- Death Certificates.
- Nursing Home transfer forms / orders.
- MeritCare prescription assistance program.
Requests for forms completion for prescription assistance programs outside of the MeritCare program will be charged (i.e. mail order, non-MeritCare prescription assistance program).
Paying $20 for the completion of a form may not necessarily replace the need for an appointment.