All Government Forms in Utah

Form Title	Agency	Jurisdiction
113b Summary of Medical Record – Occupational Exposure	Anti-Discrimination	Utah
1-2 Authorization to Furnish Information and Release from Liability	Services for People with Disabilities	Utah
1-2 Authorization to Furnish Information and Release from Liability	Health Facility Licensure	Utah
1-2 Authorization to Furnish Information and Release from Liability	HIV/AIDS/TB Control, Bureau	Utah
1391 Instructions	Department of Transportation	Utah
1444 Instructions	Department of Transportation	Utah
152 Appointment of Counsel	Department of Labor Commission	Utah
152 Appointment of Counsel	Occupational Safety & Health	Utah
152 Appointment of Counsel	Anti-Discrimination	Utah
1-6 Invitation to Submit Offer to Provide Services	Services for People with Disabilities	Utah
1-6 Invitation to Submit Offer to Provide Services	Health Facility Licensure	Utah
1-6 Invitation to Submit Offer to Provide Services	HIV/AIDS/TB Control, Bureau	Utah
18 Request for ICD-10 Code From A Diagnosing Professional	Services for People with Disabilities	Utah
18 Request for ICD-10 Code From A Diagnosing Professional	Health Facility Licensure	Utah
18 Request for ICD-10 Code From A Diagnosing Professional	HIV/AIDS/TB Control, Bureau	Utah
19C Eligibility for ID-RC Services	Services for People with Disabilities	Utah
19C Eligibility for ID-RC Services	Health Facility Licensure	Utah
19C Eligibility for ID-RC Services	HIV/AIDS/TB Control, Bureau	Utah
2018 Medical Fee Standards	Department of Labor Commission	Utah
2018 Workers’ Compensation Quick Reference Guide	Department of Labor Commission	Utah