Get Started with Nevada Docs Agency

For your convenience, we have provided links to all of the documents relevant to the application process. Please be sure to sign and date the signature lines on the main application, the Retroactive Coverage Form, and all Supplemental Claim Forms. You should then print and fax the completed documents to us at 702-947-4488.

Physician and Surgeon Application:

Health Care Facility Application:

Non-Physician Provider Application: