Collier County : Member Services

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Medical Claim Forms
The following documents are provided for the convenience of the Collier County sheriff's Office members and their families:

FSA Reimbursement Form	This form is used for Dependant Care Reimbusement and MedFlex Claims
Insurance Claim Cover Sheet	This form is used for Health, Vision and Dental
Insurance Information Change	This form is used when there is a change in your information

Health Provider List

First Health
Collier County

First Health

Collier County

If you need to find a provider outside of Collier County, you can check the internet address www.myfirsthealth.com or call 1.800.226.5116. Look for the Plan Vista Solutions for the network CCSO uses outside of Collier County. If you have questions call First Service Administrators Customer Service at 1.800.226.3155 or our inhouse representative at 530-9650.

Sick Leave Forms

Family Leave Request Form
Sick Leave Bank Use Form and Instructions
Care Giver Leave Form
Physician's Statement - LEO
Physician's Statement - Jail
Physician's Statement - Civilian (Office/Inside)
Physician's Statement - Civilian (Outside)

Family Leave Request Form

Sick Leave Bank Use Form and Instructions

Care Giver Leave Form

Physician's Statement - LEO

Physician's Statement - Jail

Physician's Statement - Civilian (Office/Inside)

Physician's Statement - Civilian (Outside)

Please direct any questions to CCSO Human Resources.

Click for the Members Assistance Program.