INSTRUCTIONS: CONNECTICUT SURETY BOND – MOTOR VEHICLE (Form K-158)

A motor vehicle dealer, motor vehicle repairer, limited motor vehicle repairer or leasing or rental motor vehicle business in Connecticut uses a form K-158 to document a bond filed as surety with the state. This document can be obtained from the website of the government of Connecticut.

Connecticut Surety Bond – Motor Vehicle K-158 Step 1: In the first blank box, check the first box if you are documenting the $50,000 bond due from a motor vehicle dealer.

Connecticut Surety Bond – Motor Vehicle K-158 Step 2: Check the second box if you are documenting the $5,000 due from a motor vehicle repairer or limited motor vehicle repairer.

Connecticut Surety Bond – Motor Vehicle K-158 Step 3: Check the third box if you are documenting the $10,000 bond due from a leasing or rental motor vehicle company.

Connecticut Surety Bond – Motor Vehicle K-158 Step 4: In the second blank box, enter the surety bond number.

Connecticut Surety Bond – Motor Vehicle K-158 Step 5: In the third blank box, enter the full name of the licensee as principal.

Connecticut Surety Bond – Motor Vehicle K-158 Step 6: In the fourth blank box, enter the dealer, repairer or leasing license number if you are currently licensed by the Department of Motor Vehicles.

Connecticut Surety Bond – Motor Vehicle K-158 Step 7: In the fifth blank box, enter the street address, city or town, state and zip code of the licensee as principal.

Connecticut Surety Bond – Motor Vehicle K-158 Step 8: In the sixth blank box, enter the full name of the surety company.

Connecticut Surety Bond – Motor Vehicle K-158 Step 9: In the seventh blank box, enter the street address, city or town, state and zip code of the surety company.

Connecticut Surety Bond – Motor Vehicle K-158 Step 10: In the eighth blank box, enter the state under whose laws the surety company was organized and exists.

Connecticut Surety Bond – Motor Vehicle K-158 Step 11: At the bottom of the page, both the principal and the attorney-in-fact of the surety company should sign and print their names, as well as providing their title. Both parties must have their signature witnessed by two witnesses, who should provide their signatures, printed names and titles as well.

INSTRUCTIONS: CONNECTICUT REQUEST FOR EXTERNAL REVIEW

A Connecticut patient who has been denied health insurance coverage for a procedure may request an external review from the state's Insurance Department by using the form discussed in this article. This document can be obtained from the website of the government of Connecticut.

Connecticut Request For External Review Step 1: The first section concerns the person who is requesting the external review. Enter your name on the first blank line.

Connecticut Request For External Review Step 2: Enter the applicant address on the second blank line.

Connecticut Request For External Review Step 3: Enter the applicant daytime phone number on the third blank line.

Connecticut Request For External Review Step 4: Enter the applicant email address on the fourth blank line.

Connecticut Request For External Review Step 5: Indicate with a check mark whether the applicant is the enrollee or patient, the parent of a minor child under 18, the provider, or a legal or authorized representative.

Connecticut Request For External Review Step 6: The second section concerns the enrollee or patient who had their request for medical care denied. Enter their name on the first blank line, their address on the second blank line and their phone number on the third blank line.

Connecticut Request For External Review Step 7: The third section concerns the insurance company. Enter the insurance company or health plan name on the first blank line, the subscriber name on the second blank line, the subscriber insurance identification number on the third blank line and the dependent insurance identification number on the fourth blank line.

Connecticut Request For External Review Step 8: Indicate whether the coverage is an individual plan, a group plan through an employer, or a group plan through a plan sponsor with a check mark.

Connecticut Request For External Review Step 9: The fourth section concerns the provider. Enter the name of the treating physician on the first blank line, their address on the second blank line, the name of a contact person on the third blank line, their email address on the fourth blank line, and their telephone number on the fifth blank line.

Connecticut Request For External Review Step 10: Provide an explanation for your appeal where indicated.

Connecticut Request For External Review Step 11: Complete the second page as instructed. The third and fourth pages should be completed by the physician.

INSTRUCTIONS: ALABAMA APPLICATION FOR REGISTRATION OF PHYSICIAN ASSISTANT 

To register a physician assistant in Alabama, use the application discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Application For Registration Of Physician Assistant Step 1: The first page should be completed by the physician. On the first blank line, the physician should enter their name in full.

Alabama Application For Registration Of Physician Assistant Step 2: On the second blank line, the physician should enter their Alabama medical license number.

Alabama Application For Registration Of Physician Assistant Step 3: On the third blank line, the physician should enter their date of birth.

Alabama Application For Registration Of Physician Assistant Step 4: On the fourth blank line, the physician should enter their Social Security number.

Alabama Application For Registration Of Physician Assistant Step 5: On the fifth blank line, the physician should enter their medical specialty.

Alabama Application For Registration Of Physician Assistant Step 6: The physician should indicate whether they are board certified or board eligible by circling "Yes" or "No" as appropriate.

Alabama Application For Registration Of Physician Assistant Step 7: On the sixth blank line, the physician should enter their principal practice location address. If their mailing address is different, they should enter it on the seventh blank line.

Alabama Application For Registration Of Physician Assistant Step 8: On the eighth and and ninth blank line, the physician should enter their telephone and fax numbers.

Alabama Application For Registration Of Physician Assistant Step 9: In section 1, the physician should provide the name, practice site address and designated working hours per week of each physician assistant  and/or CRNP and/or CNM currently registered to them.

Alabama Application For Registration Of Physician Assistant Step 10: In section 2, the physician should indicate with a check mark whether they have ever had a physician assistant certified or registered to them by the Alabama Board of Medical Examiners. In section 3, the physician should indicate with a check mark whether the physician assistant for whom registration is sought is employed by them, their group, partnership or professional corporation. They should sign and date the bottom of the page.

Alabama Application For Registration Of Physician Assistant Step 11: Complete the second page as instructed.