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    • DOC
    • COBRA Model General Notice - dol.gov

      www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/...

      [add if Plan provides retiree health coverage: ... the Patient Protection and Affordable Care Act, and other laws affecting group health plans, ...


    [add if Plan provides retiree health coverage: ... the Patient Protection and Affordable Care Act, and other laws affecting group health plans, ...



    United States Government Application Cover Page Please print, fill out, and use this form as the cover page to fax your application materials to the fax


    • PPTX
    • PowerPoint Presentation

      www.va.gov/opa/choiceact/documents/UEXB-Flyer.pptx

      Veterans Choice Program . Details on the Unusual or Excessive Burden Eligiblity Criteria. Veterans who are enrolled in the VA health care system . and


    Veterans Choice Program . Details on the Unusual or Excessive Burden Eligiblity Criteria. Veterans who are enrolled in the VA health care system . and



    Office Use Only: Certificate of Immunization Status (CIS) For Kindergarten-12th Grade / Child Care Entry . Please print. See back for instructions on how to fill out ...



    APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS. ... WHAT IS YOUR REGISTRY/ CERTIFICATION NUMBER ... (As a provider of health care services, ...


    • PDF
    • Skilled Nursing Facility (SNF) Checklist - Medicare

      https://www.medicare.gov/files/skilled-nursing-facility-checklist.pdf

      Use your completed checklist with the quality of care information ... Name of skilled nursing facility (SNF): Date of visit: Yes No Comments Basic information


    Use your completed checklist with the quality of care information ... Name of skilled nursing facility (SNF): Date of visit: Yes No Comments Basic information


    • DOC
    • APPLICATION FOR CONTINUING CARE SERVICES

      www.mass.gov/eohhs/docs/dmh/forms/form-adult...

      No health insurance Medicare One Care Medicare/Medicaid Application for Health Insurance Pending Please Specify ... APPLICATION FOR CONTINUING CARE


    No health insurance Medicare One Care Medicare/Medicaid Application for Health Insurance Pending Please Specify ... APPLICATION FOR CONTINUING CARE



    Nursing Assistant Certification by Interstate Endorsement If you hold an active Nursing Assistant Certification in another state, you may qualify for


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