Call Us Toll Free 888.990.2676

Four Convenient Locations: Blairsville | Indiana | Punxsutawney | Johnstown

portal-button

Information

Site Disclaimers
Privacy Policy
Insurance Plans for COSM.pdf

Forms

Workers’ Compensation
WORKERS COMPENSATION VISIT INFORMATION 05-2013.pdf
Work Comp Billing Information Form 05-2013.pdf
Release Additional Record to Work Comp Letter 05-2013.pdf
Nurse Reviewer Appointment Form 05-2013.pdf
Nurse Case Manager Instruction Letter 05-2013.pdf
AUTHORIZATION FOR RELEASE OF WC Visit 2-17-11 (2).pdf

General Forms
Release COSM Records Auth 9-1-13.doc
Release Patient Records to COSM 9-1-13.doc
History Review of System 05-2013.pdf

Download instructions:
– Right-click on the file/form you need
– Choose “Save target as…”
– Choose a folder on your hard drive that you will remember.
– Click OK.
– You can now open the file(s) you saved to your hard drive with Adobe Acrobat Reader.