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Office of Insurance Regulation

Company Admissions

Managed Care

Prepaid Health Clinic

NOTICE: Form OIR-C1-905 "Instructions for Furnishing Background Investigative Reports", has been revised. Applications submitted after January 1, 2005 that do not follow the revised instructions may be returned as incomplete.

ALL FORMS

Approved Prepaid Health Clinic Application Package

OIR-C1-483

PREPAID HEALTH CLINIC APPLICATION FOR CERTIFICATE OF AUTHORITY

OIR-C1-BAL-PHC

PREPAID HEALTH CLINIC

OIR-C1-903

REQUEST FOR PAYMENT OF FINGERPRINT CHARGES

OIR-C1-905

INSTRUCTIONS FOR FURNISHING BACKGROUND INVESTIGATIVE REPORTS

OIR-C1-938

FINGERPRINT CARD INSTRUCTIONS

OIR-C1-1423

BIOGRAPHICAL AFFIDAVIT