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Student Information Waiver Form 2021 2022
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A comprehensive form for student registration and information collection for a band program, including contact details, emergency information, and authorization for information release.
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Emergency Medical Form
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Comprehensive medical information and emergency contact form for school students with parent and emergency contact details.
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2022 2023 STUDENT EMERGENCY CONTACT FORM
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A comprehensive form for collecting student contact details, emergency contacts, and medical information for school records.
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WILDERNESS ADVENTURES ACKNOWLEDGMENT AND ASSUMPTION OF RISKS RELEASE AND INDEMNITY AGREEMENT
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Legal document outlining risks, liability release, and participant agreement for Wilderness Adventures outdoor programs.
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Application form for members of the Philippine Obstetrical and Gynecological Society to claim sickness benefits
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Form for submitting warranty claims for prosthetic products and detailing product and patient information.
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Grant application form for LHA Trust Funds members seeking funding for healthcare-related projects, with a maximum award of $25,000.
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Idaho Health Examination And Consent Form
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Required medical examination form for Idaho high school students participating in interscholastic athletics in 9th and 11th grades.
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47th Annual High School Student Art Competition Entry Form
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Official entry form for high school students participating in the annual art competition hosted by Quincy Art Center.
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King Hall Outreach Program Recommendation Waiver Form
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A confidential form for applicants to waive access rights to letters of recommendation for the King Hall Outreach Program.
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2021 Maximum Per Unit Total Development Cost Waiver Form
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Form for requesting a waiver for maximum per unit total development costs for housing projects in Georgia.
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Employee Medical Inquiry Form
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Medical form for employees requesting workplace accommodations, to be completed by both employee and healthcare provider to assess disability and potential workplace adaptations.
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2021 States 4 H OB Medical Form (Non Japan)
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Medical history and health assessment form for participants in a cross-cultural youth exchange program.
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2021 Olympic Day Colouring And Drawing Competition Entry Form
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Entry form for a youth art competition celebrating Olympic themes and sports for various age categories.
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Cardiology Medical History Form
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Comprehensive medical history form for cardiology patients to document health conditions, medications, and allergies.
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Permission To Participate Medical Treatment Consent And Release, Waiver, And Indemnity Agreement
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A comprehensive form granting permission for a child to participate in church activities and providing medical treatment consent and liability release.
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Rental Agreement Form
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A rental agreement form for ski and snowboard equipment rental at Mohawk Mountain, including personal information, equipment details, and liability waiver.
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YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
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A medical release form for youth and junior volleyball players to document health information and parental consent for participation.
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Via West Participant Application
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Registration packet for participants with required forms for camp enrollment in 2021.
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Walker Waiver Form
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Waiver form for participants in an ALS of Michigan walking event, releasing organizers from liability and granting media usage permissions.
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Cheyenne Frontier Days Old West Museum Proxy Purchase Policy And Application
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Policy for purchasing artwork remotely through a proxy system at the Cheyenne Frontier Days Western Art Show and Sale
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Course Waiver Request
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A form used by students to request a waiver for course prerequisites or corequisites at Florida Institute of Technology.
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Patient Intake Form
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Comprehensive patient registration and consent form for physical therapy services with contact, insurance, and treatment agreement details.
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Release And Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement
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Legal document releasing 3Point0 Studio T from liability for potential injuries or damages during participation in activities.
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City Of Ukiah Business Emergency Contact Form
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A form for businesses to provide emergency contact information to local police and fire departments in Ukiah, California.
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Emergency And Contact Information Form
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A comprehensive form for collecting student contact, emergency, and family information for school records.
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2022 2023 Membership Application
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Comprehensive membership application for youth program registration with detailed member and family information
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ParentGuardian Consent And Medical Release Form For 2022 23 JSMC Youth And Junior Youth Events
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A consent form for parents/guardians to authorize child participation in church youth events and provide medical information
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Privit Profile Instructions For Students
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Comprehensive guide for students to create and complete their digital health record using Privit Profile platform for Wilmington College.
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2022 23 SBHC Patient Intake Form
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Comprehensive medical intake form for patients at Generations Family Health Center, collecting personal, contact, and demographic information.
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New York FFA Association Waiver, Release Of Liability, Consent To Medical Attention, Authorizations
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Waiver form for New York FFA Association event participation, covering liability, medical consent, and risk acknowledgment.
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FAM Fellowship Application
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Application form for a paid academic-year fellowship at the Frist Art Museum designed for students and emerging professionals interested in museum exhibition processes.
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Claim Form
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A comprehensive claim form for medical reimbursement from GlobeMed Qatar/SEIB insurance network covering various healthcare services.
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Grand Staircase Escalante National Monument 2022 Artist In Residence Application Form
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Application form for artists seeking a residency at Grand Staircase Escalante National Monument in partnership with Escalante Canyons Art Festival.
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WILDERNESS ADVENTURES ACKNOWLEDGMENT AND ASSUMPTION OF RISKS RELEASE AND INDEMNITY AGREEMENT
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Legal document outlining risks, liability release, and participant agreement for wilderness adventure activities.
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POGS MAP Sickness Benefit Application Form
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A form for members of the Philippine Obstetrical and Gynecological Society to apply for sickness benefits for medical and COVID-related conditions.
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2022 Art Installation Questionnaire
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A questionnaire for artists seeking to install art on the open playa at the Burning Man event, requiring online electronic submission of project details.
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BHC Non Surgical Program Registration Form
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Registration form for patients seeking admission to a non-surgical program at Boone Hospital Center, collecting comprehensive personal and medical information.
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Carving Competition Entry Form
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Official entry form for the International Wood Carvers Association (IWCA) decoy carving competition with multiple classification categories.
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Notice Of Privacy PracticeClinics
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A consent form documenting patient acknowledgment of privacy practices and permissions for health information disclosure and communication.
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Adult Medical Release Form
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Medical information and emergency authorization form for adult participants of the Summit Music Festival
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HEALTH ASSESSMENT FORM
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A screening questionnaire to assess potential COVID-19 exposure and symptoms for convention attendees.
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Long Term Disability Claim Form Statement Of Employee
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A comprehensive form for employees to file a long-term disability claim with Lincoln Financial Group, detailing personal, employment, and medical information.
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MEDICAL HISTORY FORM
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Comprehensive medical form for documenting student's health history, childhood illnesses, current physical conditions, and immunization records.
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PATIENTS INTAKE FORM
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Comprehensive medical intake form for patient registration and insurance information at a podiatry medical practice.
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IMPACT GRANT APPLICATION FORM
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A comprehensive form for submitting grant proposals at Ridge Meadows Hospital with detailed sections for applicant information, project summary, and departmental approvals.
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Intent To Purchase (ITP) Bid Form
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Bid form for sealed auction of art pieces by notable Western artists at the Charles M. Russell Museum
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Easter Seals Colorado Rocky Mountain Village Camper Medical Form
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A comprehensive medical form for documenting a camper's health status and medical history prior to attending camp.
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Medical Release Form
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Medical consent and emergency contact form for minors attending music camp programs at Sam Houston State University
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Form For Documenting Medical And Physical Disabilities
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A form for healthcare professionals to document student medical disabilities and support academic accommodation requests.
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Emergency And Contact Information Form
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A comprehensive form for collecting student contact and emergency information for the 2023-2024 academic year.
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Garden Grove Teen Action Collaborative ApplicantS Information
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Consent and liability waiver form for participants in Garden Grove recreational programs and activities, specifically targeting teens.
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2023 2024 Membership Application
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Application for youth membership program covering the period from July 2023 to June 2024, collecting comprehensive child and family information.
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MLS Waiver Application Form
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Form for real estate professionals to request exemption from MLS agent fees based on specific qualifying conditions.
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2023 2024 Northside ISD Medical History
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Annual medical history form required for student participation in athletic activities at Northside Independent School District.
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NACSW Frequent Volunteer Reward Program
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Form detailing guidelines for earning additional trial entry draws through volunteer service at NACSW events.
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Annual Pre Participation Physical Evaluation
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A comprehensive medical screening form for student-athletes to assess their health and fitness for sports participation during the 2023-24 school year.
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2023 2024 Student Emergency Form
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A comprehensive form for collecting student emergency contact details, health insurance information, and parental contact information for school records.
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ASCVTS Bundang Thoracic Fellowship Program Application Form
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Application form for medical professionals seeking a fellowship in cardiovascular and thoracic surgery with the Asian Society for Cardiovascular and Thoracic Surgery.
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DNRC General Clauses To Emergency Equipment Rental Agreement
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A rental agreement for emergency equipment with specific terms and conditions for equipment usage during incidents.
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DNRC General Clauses To Emergency Equipment Rental Agreement
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Standard rental agreement for emergency equipment with detailed clauses covering equipment requirements, liability, and operational conditions.
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2023 Teen Expeditions Questionnaire And Medical Form
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Comprehensive medical questionnaire for participants of Lake Champlain Maritime Museum teen expeditions to ensure safety and proper medical support.
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Preparticipation Physical Evaluation History Form
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Comprehensive medical history form for athletes to evaluate health status and potential medical concerns prior to sports participation
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ICS 213 General Message
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A form for documenting and approving lodging, per diem, and fuel expenses for emergency resources under CFAA mobilization.
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PATIENT INTAKE FORM
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A comprehensive form for patients to complete and schedule appointments at various PanCare Health clinics in Florida counties.
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2023 JCC Maccabi Teen Medical Form
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Medical examination form for teens participating in JCC Maccabi sports and arts activities to verify physical fitness and health status.
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Student Medical Information
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A comprehensive medical form for collecting student health details, emergency contacts, and insurance information for educational program participation.
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2023 Rechelle Turner Basketball Camps Medical Release Form
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Medical release and consent form for participation in basketball camp, including emergency contact and insurance information.
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PA Schedule E Rents And Royalty Income (Loss)
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Tax form for reporting rental property income, royalties, and related expenses for Pennsylvania taxpayers.
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PW Hong Memorial Fellowship Program Application Form
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Application form for medical professionals seeking a fellowship with the Asian Society for Cardiovascular and Thoracic Surgery
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Brother Joseph Miggins Service Program Proposal Form
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A student proposal form for documenting community service project details and intended service activities.
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Pre Authorization Request Form
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A medical pre-authorization form for healthcare providers to request service approval from UHSM, detailing patient and provider information.
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Pre Authorization Request Form
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A form for healthcare providers to request pre-authorization for medical services from UHSM with detailed documentation requirements.
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Course Substitution And Waiver Form
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A form for students to request course substitutions or prerequisite waivers at Leech Lake Tribal College.
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Invoice Form For Morphology
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A detailed medical form for collecting patient morphological diagnostic information related to hematological conditions.
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Scholarship Application Form
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A comprehensive scholarship application for artists seeking financial support for art classes, requiring detailed personal and artistic information.
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2024 2025 Benefits Enrollment Form
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Form for employees to select health benefit plans, add or remove dependents, and update personal information for the upcoming benefits year.
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Emergency And Contact Information Form
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Form for collecting student emergency contact details and family information for school records.
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Garden Grove Teen Action Collaborative ApplicantS Information
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Waiver and consent form for participating in City of Garden Grove recreation programs, events, or activities for teens.
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Group Medical Plan Waiver Form
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A form for employees to waive medical plan coverage by certifying alternative health insurance coverage and understanding ACA requirements.
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TAPPS MEDICAL HISTORY FORM
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Annual medical history form for students participating in TAPPS athletic and fine art activities to assess health risks.
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Annual Pre Participation Physical Evaluation
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Medical evaluation form for student-athletes to assess physical fitness and health conditions for sports participation.
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2024 2025 Sports Qualifying Physical Examination Medical Eligibility Form
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Medical form for determining student athletes' medical eligibility and participation in high school sports
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Sports Physical Examination Form
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Comprehensive medical evaluation form for students participating in school sports, requiring parental authorization and medical provider assessment.
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MEDICAL EXAMINATION FORM
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Medical form to assess physical and mental fitness of individuals applying for motorcycle event participation licenses.
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MEDICAL HISTORY FORM
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Comprehensive medical history form for capturing individual health details, medical conditions, and consent for medical information sharing.
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MEDICAL EXAMINATION FORM
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A comprehensive medical examination form to assess physical and mental fitness for participating in motorcycle events.
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2024 Arizona EL Teacher Of The Year Nomination Form
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Nomination form for recognizing outstanding English Language teachers in Arizona for the 2024 award year.
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RULES AND REGULATIONS
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Comprehensive guidelines for cattle exhibition at a fair, including entry requirements, health regulations, and ownership rules.
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FIDA Application Form
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Application form for submitting project proposals to the Fund for the International Development of Archives (FIDA), an initiative of the International Council on Archives (ICA).
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Patient Demographic Form
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A comprehensive form for collecting patient personal, contact, and insurance information for medical services.
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Ascension Illinois Influenza Vaccination Billing Form
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Medical form for collecting patient information for influenza vaccination and billing purposes.
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Child Medical Disclosure Form
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Medical information and emergency contact form for children attending summer camp, including health history and parental consent for medical treatment.
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Jersey Shore School Education Foundation Student Scholarship Form
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A scholarship opportunity for Jersey Shore Area High School graduating seniors pursuing healthcare-related college programs with awards of $1000 for one four-year and one two-year program recipient.
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2024 Health Insurance Waiver Form
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Form for employees to waive health insurance coverage and provide proof of alternative coverage under Affordable Care Act regulations.
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Kamehameha Schools Summer Programs Medical Forms
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Medical evaluation and health history form for children participating in Kamehameha Schools Summer Programs, requiring physical examination and immunization documentation.
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HPU Incoming Student Health Information And Immunization
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Comprehensive health form for incoming students at High Point University, including immunization records and medical consent.
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HSA Payroll Deduction Form 2024
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A form for employees to authorize payroll deductions for Health Savings Account contributions with IRS contribution limits and University contribution details.
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Permit To Install Or Alter A Sewage Treatment System
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Official permit document for installing, replacing, or altering a sewage treatment system in Ohio, issued by the Ohio Department of Health.
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Pre Employment Health Clearance Requirements
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Comprehensive health screening requirements for new medical residents and fellows, including medical history, immunizations, and occupational health screenings.
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Incoming Trainee Timeline August 1, 2024
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Comprehensive timeline and requirements for incoming medical trainees, detailing necessary documentation and submission processes for licensing and staff appointment.
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2024 HIGH PERFORMANCE PLAYER WAIVER FORM
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Waiver and registration form for participants in athletic club activities, covering personal and emergency information along with liability release.
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2024 UNC Soccer Camp MEDICAL FORM
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Medical history and health screening form for participants of UNC Soccer Camp, required for camp participation.
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Medical History And Physical Examination Form
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Medical history and physical examination document for racing car drivers to assess fitness and health conditions for licensing.
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Eugene Metro Futbol Club Medical Release Release Of Liability Form
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Medical and liability consent form for youth soccer player registration and participation in soccer programs.
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Jr All American Of Southern California Conference Mandatory Medical Release Form
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Medical history and physical examination form required for youth athletes participating in Jr All American of Southern California Conference sports programs
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BOAT NUMBER ACCIDENT WAIVER AND RELEASE OF LIABILITY
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Legal waiver for participants in the Missouri American Water MR340 river race, acknowledging significant physical risks and releasing event organizers from liability.
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PLAN YEAR 2024 ENROLLMENTCHANGE FORM MEDICAL SPENDING CONVERSION (MSC) HEALTH BENEFITS BUY OUT WAIVE
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Enrollment form for New York City employees to participate in or terminate health benefits buy-out waiver program for plan year 2024.
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GENERAL MEDICALPHYSICAL EXAM FORM
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Medical examination form for veterans participating in the National Veterans Summer Sports Clinic, to be completed by a clinician.
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20232024 Season
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Registration and medical information form for volleyball team participants, including contact details, medical history, and insurance information
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Procurement Form 2024
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Official submission form for the 32nd Annual Museum of Northwest Art (MoNA) Art Auction, collecting artwork donation details and artist information.
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St. Charles Park District Registration Form
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Registration form for participating in St. Charles Park District programs and activities, including waiver and participant information.
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Shipping Form For New York State Fair Entries
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Shipping guidelines and form for submitting entries to the Wegmans Art & Home Center at the New York State Fair.
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2024 North Texas Soccer Tournament Of Champions Team Medical Release Confirmation Form
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A form confirming that medical release forms for players have been collected and will be available during tournament games.
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Credentials Check List For Tournament Teams
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Detailed guidelines for tournament team documentation and eligibility verification for Dixie Boys Baseball (DBB) tournaments.
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Provincial Winter Fair Release Of Liability Acknowledgement Of Risk
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Legal document releasing liability for participants in provincial fair activities involving livestock and events
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2025 Provider Referral Form
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A medical referral form for patients seeking enrollment in weight management or diabetes management programs through the Florida Department of Management Services.
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2025 ABC Travelling Fellowship Application Form
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Application for Canadian orthopaedic surgeons to participate in an international medical exchange fellowship program in the United Kingdom, Australia/New Zealand, or South Africa.
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2026 Canadian Wildlife Habitat Conservation Stamp And Print Artist Agreement
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Legal agreement for artists participating in the 2026 Canadian Wildlife Habitat Conservation Stamp and Print competition, outlining terms and conditions of participation.
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Disability Insurance Claim Packet Instructions
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Comprehensive guide for applying for disability insurance benefits through Standard Insurance Company, detailing claim submission process and requirements.
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Health Services Referral Form
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A comprehensive referral form for various health services targeting children, youth, and pregnant women in Mississippi.
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SoonerCareInsure Oklahoma Referral Form
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A referral form for healthcare providers to refer patients for medical services within the SoonerCare/Insure Oklahoma program.
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Alabama First Class Pre K Program Appendix F DECE Incident Report Form
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A standardized form for reporting serious accidents, injuries, medical situations, or behavior incidents in the Alabama First Class Pre-K Program.
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2020 Eve Gene Black Summer Medical Career Program FAQs
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Comprehensive guide for a medical mentor/internship program for students in Los Angeles and adjacent counties
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Everence HSA Contribution Form
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A form for making individual contributions to a Health Savings Account through Everence Federal Credit Union with tax year specification options.
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Apricus Referral Form
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A comprehensive medical referral form for patient discharge planning and facility care management services.
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Calgary Sketch Painting Club Exhibition Form
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A form for artists to submit details about their artwork for a Calgary Sketch & Painting Club exhibition.
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ART SHOW INVENTORY FORM
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A form for artists to record artwork details, sales information, and track commission and payments during an art exhibition.
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MyFitRx And Kids On The Move Reimbursement Form
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A reimbursement form for members participating in MyFitRx or Kids on the Move fitness programs, offering up to $50 per benefit year.
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Physician Examination Form
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A comprehensive medical form required for students to provide health information and undergo physical examination prior to campus arrival.
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Participant Liability Release And Waiver Form
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A comprehensive liability release form for participants in cheer and dance events organized by Varsity Spirit LLC.
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USA Volleyball Incident Report Form
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Comprehensive form for documenting injuries or property damage during USA Volleyball events
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Monthly Grant Funding (MGF) Payment Inquiry Form
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Form for community partner clinics to inquire about missing grant funding payments for enrolled participants.
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CCS Administrative Procedure 2.30.05 E Confined Space Entry
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Administrative procedure outlining safety protocols and requirements for entering confined spaces at Community Colleges of Spokane.
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PATIENT FEEDBACK FORM
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A form designed for patients to provide feedback or file complaints with Big Island Healthcare, allowing anonymous submission and formal review process.
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NEW PATIENT INTAKE FORM
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Comprehensive medical intake form for collecting new patient health information, medical history, and family health background.
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Enrollment Form
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A comprehensive form for collecting student and family details, including contact information, family history, and hearing loss information.
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Student Medical Form
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Comprehensive medical form for collecting student health information, medical history, and emergency contact details.
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Notice Of Serious Incident
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Official documentation of a medical incident involving a resident at a behavioral health facility who experienced seizures and required medical transport.
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COMMONWEALTH OF MASSACHUSETTS CATEGORICAL TUITION WAIVER APPLICATION 2024 2025
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Application for tuition waiver categories at Cape Cod Community College for eligible students including veterans, seniors, and other special categories.
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Emergency Contact Form
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A comprehensive emergency contact and medical information form for high school band and dance students in Fort Bend Independent School District.
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24 25 Physical Examination Form
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Medical form for student athletes to document physical fitness and health status for school sports participation.
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2024 Nomination Form
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A comprehensive nomination form for an award, requiring detailed nominee information and supporting documentation.
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Accommodation Request EmployeeS Serious Health Condition Medical Form
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A form for employees to request workplace accommodations due to serious health conditions, requiring medical provider verification and details.
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Club Sport Waiver 2024 2025
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Legal waiver for Villanova University students participating in club sports during the 2024-2025 academic year, acknowledging potential risks and releasing the university from liability.
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UC ANR Waiver
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A legal waiver for participants attending the 2018 Western Region Leaders Forum events, releasing the University of California from liability for activities and potential risks.
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DSS Form 2901 Medical Statement
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Medical health form for staff, volunteers, and emergency personnel working in child care services, documenting health history and tuberculosis status.
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Medical Statement
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A medical health screening form for staff, volunteers, and emergency personnel working in child care settings in South Carolina.
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Medical Statement
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Medical health screening form for staff, volunteers, and emergency personnel in child care services in South Carolina.
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GSDCA DM Research Sample Volunteer Form
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A research form for collecting cheek-swab DNA samples from purebred German Shepherd Dogs to study degenerative myelopathy genetic factors.
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Non UH Event Or Activity Participant Consent, Waiver, Release And Indemnity Agreement
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Legal document outlining participant consent, risk acknowledgment, and liability release for non-University of Hawaii events or activities.
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Participant Consent, Waiver, Release And Indemnity Agreement Non UH Event Or Activity
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A legal consent and release form for participants in non-University of Hawaii events, outlining health representations, risk assumptions, and liability waivers.
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CLAIM FORM FOR HEALTH DEPENDENT CARE EXPENSES
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A form for employees to request reimbursement for health and dependent care expenses through their Flexible Spending Account (FSA)
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University Of Kentucky Medical Inquiry Form In Response To An Accommodation Request
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Medical form used to assess an employee's disability status and potential accommodations under the Americans with Disabilities Act (ADA)
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PATIENT MEDICAL HISTORY FORM
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Comprehensive medical form capturing patient personal information, current medications, allergies, and past medical history details.
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New Patient Intake Form
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Comprehensive medical intake form for new patients seeking holistic healthcare at the Riordan Clinic, collecting detailed personal and medical information.
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Dohn Community High School 301 Wellness Policy Compliance Form
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A form for documenting wellness committee membership, meeting dates, and policy evaluation for a community high school.
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Laboratory Supply Order Form
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Form for ordering laboratory specimen collection and shipping supplies for various medical testing needs.
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30 Days Needs Assessment Form Status
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Form used to document assessment status and communication attempts with migrant student families within 30 days of initial contact.
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Camp Blue Spruce Medical Form 2016
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A comprehensive medical form for campers to provide health and emergency contact information for Camp Blue Spruce summer camp.
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PIP Checklist
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A comprehensive checklist for healthcare providers to ensure complete documentation and submission of required forms for personal injury protection insurance claims.
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Rotation Assessment Form
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A medical assessment form for evaluating thoracic spine mobility and potential biomechanical issues.
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AAOS CME SKILLS COURSE REGISTRATION FORM
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Registration form for AAOS Fundamentals of Knee & Shoulder Arthroscopy course for orthopaedic residents in September 2024.
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Ohio Administrative Code Rule 3344 94 03 Policy
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Administrative policy outlining safety and communication protocols for university programs involving minors, including emergency procedures and medical considerations.
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Standardized Application For Pathology Fellowships
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Comprehensive application form for physicians seeking pathology fellowship training at the University of Texas Southwestern Medical Center.
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ARTH 395 Internship Application Form
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Application form for students seeking an internship through the Art Department at their academic institution.
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Incident Report Form
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A comprehensive form for documenting workplace or program-related incidents, including details about the incident, individuals involved, and follow-up actions.
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MEDICAL HISTORY FORM
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Comprehensive medical form collecting patient personal health information, medical history, family history, and COVID-19 screening details.
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REENTRY (REPS) SERVICE REQUEST FORM
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A form used by healthcare providers to request medical services for patients in the California Department of Corrections and Rehabilitation system.
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PAXLOVID ORDER FORM FOR OUTPATIENT ORDER SET PER FDA EUA
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Medical order form for prescribing Paxlovid, an emergency use authorization (EUA) medication for treating mild-to-moderate COVID-19 in eligible patients.
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Volunteer Coaching Release Of Liability
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Legal document releasing the university from liability for risks associated with volunteer coaching activities.
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Waiver Of Service Period For Retirement Plan Participation
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A form allowing employees to waive the one-year service requirement for retirement plan participation based on previous employment at eligible organizations.
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HIPAA 404P Authorization To Release Or Obtain Health Information
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A form for authorizing the release or obtaining of protected health information under HIPAA guidelines.
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Receipt And Waiver Of MechanicS Lien Rights
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A legal document used to waive mechanic's lien rights upon receipt of payment for labor, materials, or services provided to a property.
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System Safety Implementation Plan For The Goddard Space Flight Center Explorers Program Office
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A comprehensive safety implementation plan for NASA's Goddard Space Flight Center Explorers Program, detailing safety requirements and procedures.
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Tobacco Free Campus Policy
PDF template
Comprehensive policy prohibiting tobacco use, smoking, and tobacco product distribution on all university property for students, faculty, staff, and visitors.
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Consulting PhysicianS Compliance Form
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Medical form for documenting terminal illness assessment, patient competency, and informed decision-making for end-of-life care.
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DOH 422 066 PsychiatricPsychological ConsultantS Compliance Form
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A medical form for documenting psychiatric evaluation and patient mental health status compliance assessment.
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Hazard Incident Report Form
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A form for documenting and reporting workplace safety hazards, incidents, and recommended corrective actions.
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Electronic Funds Transfer (EFT) Waiver Request Form
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Form for requesting exemption from electronic funds transfer payments by providing specific justification to the Federal Aviation Administration.
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Medical Service Request Form
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A form for healthcare providers to request medical services for South Country Health Alliance members with detailed service and patient information.
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HealthFlex Mandatory Premium And Coverage Waiver Form
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A form for enrolled participants or new hires to decline HealthFlex health plan coverage and declare their reason for doing so.
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Youth Member Health History Information
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A comprehensive health information form for youth members participating in 4-H programs, collecting medical history, medications, and special needs information.
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SI 2047 Your Disability Benefit Claim
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Comprehensive guide and forms for applying for disability insurance benefits, including instructions for claim submission and potential benefit reductions.
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Out Of Network Reimbursement Form
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A form for employees to submit out-of-network healthcare service reimbursement claims with detailed patient and service information.
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SMAA Form 112 Demobilization Checklist
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A comprehensive checklist outlining procedures for resource demobilization and personnel return after emergency response missions.
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Four Corners Dressage And Combined Training Association Membership Application Form
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Membership application form for Four Corners Dressage and Combined Training Association with various membership levels and waivers.
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COVID 19 Participant Code Of Conduct And Risk Assessment Form
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A risk assessment and conduct guidelines form for Special Olympics participants during the COVID-19 pandemic
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Emergency Contact Form
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Form for collecting emergency contact details for property unit owners during potential hurricane evacuations.
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Authorization To Disclose Confidential Information
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A form authorizing the release of personal medical information to specified parties with details on the type and purpose of disclosure.
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NC 4 H AccidentIncident Report Form
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A comprehensive form for documenting accidents, incidents, or injuries involving youth participants, staff, volunteers, or guests at NC 4-H events.
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Georgia 4 H Participation Agreement And Waiver Form
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A legal waiver for participants in Georgia 4-H virtual programs, covering liability and consent for program participation.
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Health Requirements For Matriculation
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Comprehensive health documentation requirements for students, detailing mandatory vaccinations and immunization guidelines.
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Suburban Law Enforcement Academy Medical Examination Package
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Medical examination and approval form for police recruit candidates to assess fitness for law enforcement training program
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Patient Intake Form
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Comprehensive form for collecting patient personal, medical, insurance, and contact information for healthcare providers.
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M TIBA OUTPATIENT CLAIM AND PRE AUTHORIZATION FORM
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A comprehensive healthcare claim form for submitting outpatient medical treatment details and seeking pre-authorization for medical services.
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Human Informed Consent Form
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A template form for obtaining informed consent from research participants in science fair projects, covering voluntary participation and study details.
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Middlesex School TB Risk Assessment Form
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A medical form to assess tuberculosis risk for students by evaluating travel history, exposure, and potential testing requirements.
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Drugs And Alcohol (Athletes) Policy
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Policy governing drug testing and education for student-athletes at Western Nebraska Community College to promote health and fair competition.
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Weekly Disability Claim Form
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A comprehensive form for reporting disability status and medical information for the Greater St. Louis Construction Laborers' Welfare Fund.
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ILR Emergency Medical Form
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A comprehensive form for participants to acknowledge risks, provide emergency medical information, and grant permissions for Institute for Learning in Retirement activities.
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Disability Claim Application Forms
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Comprehensive documentation requirements for submitting a disability insurance claim with multiple form and document submission instructions.
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Required NYS School Health Examination Form
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Comprehensive health examination form for New York State school students, capturing medical history and current health status.
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Form To Be Filled By Appointee On Stipendiary Assignments Of DJST
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Application form for candidates seeking stipendiary assignments at Seth G.S. Medical College & K.E.M. Hospital Diamond Jubilee Society Trust
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Chronic Illness Benefit Application Form 2013
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Medical application form for registering chronic illness benefits with Discovery Health Medical Scheme for the year 2013
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Fitness Reimbursement Request
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Form for members to request reimbursement for qualified fitness expenses through Blue Cross Blue Shield of Massachusetts.
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UMKC School Of Dentistry Patient Referrals
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A comprehensive form for referring patients to various dental specialty clinics at the UMKC School of Dentistry.
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Aflac Continuing Disability Claim Form
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A form for submitting continuing disability claims with Aflac insurance, providing instructions for online form completion and submission.
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Seasonal Survey On Influenza Vaccination Programs For Healthcare Personnel
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A survey collecting information about influenza vaccination programs and practices for healthcare personnel across different employment groups.
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Medical Form
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A medical form for applicants to Notre Dame Seminary's Graduate School of Theology Priestly Formation Program, collecting health and insurance information.
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Personal Medical History
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Comprehensive medical history form for collecting patient health information, medical conditions, family history, and current health status.
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Written Authorization To Enroll Into School Age Program
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Authorization form for parents to enroll children aged 5 between September and January into a school age program.
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WAIVER FORM
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A legal form allowing clients to waive a real estate licensee's statutory duty to present all offers in a real estate transaction.
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FMLA Leave Request Form
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A form for employees to request leave under the Family and Medical Leave Act for various personal and family medical reasons.
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Waiver Of Compulsory Attendance Form
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A legal form allowing parents to request exemption from compulsory school attendance for a student aged 16-17 in Kansas.
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Data Processing Agreement
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Legal agreement outlining data processing terms between Jasper AI and its customers for handling personal data.
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Chair Assessment And Delivery Environmental Questionnaire
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A comprehensive form for evaluating chair specifications, sizing, and delivery requirements for personalized seating solutions.
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Gibraltar Residency Application
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A comprehensive overview of letters of intent for residency applications, explaining their purpose, benefits, and strategic writing approach.
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Student Health Information Form
PDF template
Comprehensive health information form for collecting student medical and contact details at a university
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Valley ChildrenS Healthcare Outpatient Referral Form
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A comprehensive medical referral form for patients being referred to Valley Children's Healthcare for specialized medical services.
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Medical Referral Form
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A form for reporting an individual's medical conditions that may impact their ability to safely operate a motor vehicle.
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MSDH Motivated To Live A Better Life Referral Form
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A comprehensive referral form for patients seeking health management support through the Mississippi State Department of Health's lifestyle program.
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Section 74(B) Clean Bus Energy Grant
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A grant program to replace diesel school buses with electric, propane, and compressed natural gas buses to reduce emissions and improve air quality.
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Hazard Report Form
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A form for documenting workplace safety hazards, their severity, and corrective actions.
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GIRL SCOUTS OF EASTERN OKLAHOMA COUNCIL ACCIDENTINCIDENT DAMAGE REPORT FORM
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A comprehensive form for documenting accidents, incidents, or damages occurring during Girl Scouts activities in Eastern Oklahoma.
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Athletic Injury Report (AIR) Form Information And Procedures
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Comprehensive guidelines for documenting and reporting athletic injuries in high school and middle school athletic programs.
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Medical History Form
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Comprehensive medical form for students to provide health history and undergo medical screening for enrollment.
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SSU Admission And Discharge Form
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Medical intake and release document for detainees in immigration health services facilities, tracking health status and disposition.
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Pyxis Access Request Form
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Form for healthcare professionals to request access to Pyxis medication management system in specific work areas.
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2019 Jijak Youth Camp Medical Release Form
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A comprehensive medical form for youth camp participants to provide health information, allergies, immunization status, and medical details.
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Medical History Form
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A comprehensive medical history form for sports participation, requiring detailed health information and consent statements.
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WakeMed Urgent Care Patient Intake Form
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Medical form for collecting patient health information, medical history, and current health status at urgent care facility.
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90 Day Waiver Request Form
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Form for providers to request a 90-day waiver for claims submission to MassHealth outside standard time limits.
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Emergency Contact Form
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A document for collecting emergency contact information for employees to ensure quick communication during urgent situations.
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Supplemental And Optional Contact Information For HUD Assisted Housing Applicants
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Optional form for HUD housing applicants to provide emergency contact and additional support information for their housing application.
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COVID 19 Participant Code Of Conduct And Risk Assessment Form
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A comprehensive guidance document outlining participant responsibilities and precautions for COVID-19 safety during Special Olympics activities.
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Eyer Ropes Challenge Course Release Of Liability, Waiver Of Claims, Assumption Of Risk And Indemnity
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Legal document releasing liability for participation in high-risk recreational activities at Eyer Ropes Challenge Course.
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Refund Process Policy
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A policy outlining procedures for processing refunds, credit balances, and overpayments for UCR Health patients and third-party payors.
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WakeMed Urgent Care Patient Intake Form
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Comprehensive medical form for collecting patient medical history, past surgical history, family history, and social history at an urgent care facility.
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DOT Physical Examination Form
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Medical examination form for commercial vehicle drivers to assess physical fitness for driving.
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Advancing Access Patient Information Form
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Comprehensive form for collecting patient personal information, contact preferences, and insurance details for medical services.
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Subscriber Claim Form
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A comprehensive insurance claim form for submitting medical service reimbursements to Blue Cross Blue Shield of Massachusetts.
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Waiver Of Liability Hold Harmless Agreement
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Legal document releasing Sam Houston State University from liability for risks associated with study abroad program participation.
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Medical History Form
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A comprehensive form for collecting patient medical history, current health conditions, medications, and allergies.
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Request For Waiver Form
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A form for contractors to request a waiver of Minority-Owned Business Enterprise (MBE) or Women-Owned Business Enterprise (WBE) participation goals in a procurement process.
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Insurance Office Quick Reference Guide 2017
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Comprehensive reference for filing insurance claims, emergency contacts, and reporting procedures for various types of incidents.
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GASLINI INTERNATIONAL PEDIATRIC FELLOWSHIP PROGRAM APPLICATION FORM
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Application form for medical professionals seeking a fellowship at IRCCS Istituto Giannina Gaslini's pediatric program.
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A10 Risk Assessment Policy
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A comprehensive policy outlining the school's approach to identifying and managing health and safety risks for staff, pupils, and visitors.
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SPECIAL MEETING HOD COMMITTEE VOLUNTEER FORM
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A form for volunteers to indicate interest in serving on various committees for a Special Meeting of the House of Delegates.
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Preparticipation Physical Evaluation Physical Examination Form
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Medical evaluation form used to assess an athlete's physical fitness and eligibility to participate in sports activities.
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Preparticipation Physical Evaluation Physical Examination Form
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A comprehensive medical evaluation form for athletes to assess physical fitness and clearance for sports participation.
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Amino Acid Laboratory Sample Submission Form
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A comprehensive form for submitting animal medical samples to the Amino Acid Laboratory at UC Davis for testing.
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Submission Form
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A form for authors submitting manuscripts to Acta Anaesthesiologica Scandinavica, including conflict of interest disclosure requirements.
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UNPLANNED ADMISSIONAAU BOOKING FORM
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A form for booking unplanned hospital admission to the Acute Admissions Unit with comprehensive patient and clinical details.
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AAUS Medical Evaluation Of Fitness For Scuba Diving Report
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A comprehensive medical evaluation form to assess an individual's fitness for scientific scuba diving, including required medical tests and physician's assessment.
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Alberta Accident Benefits Initial Claims Process
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A comprehensive guide for filing insurance claims and accessing medical benefits after an automobile accident in Alberta, Canada.
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AIChE BEER BREWING COMPETITION WAIVER AND RELEASE OF LIABILITY FORM
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Legal waiver for participants in an AIChE beer brewing competition, releasing the organization from potential liability and risks associated with the event.
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Directions For Completing An ABPN Feedback Module
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Instructions for psychiatry and neurology professionals to complete a peer or patient feedback module for continuous certification.
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AAPS VOLUNTEER FORM
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A volunteer form for physicians to indicate interest in committee participation and specialty opportunities within the AAPS organization.
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Hardship Waiver Form
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Form for Louisiana school districts to request a waiver of financial aid application requirements for graduating high school seniors unable to complete standard financial aid documentation.
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Clark Atlanta University Academic Program Proposal Guidelines
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Guidelines for proposing and approving new and revised academic programs at Clark Atlanta University with detailed review and routing protocols.
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Histology Submission Form
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A detailed form for submitting tissue samples to the UConn Comparative Veterinary Medicine Diagnostic Laboratory for histological processing and analysis.
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Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, medical, insurance, and contact information for healthcare services.
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Group Insurance Accelerated Benefit Option Claim Form
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A form for employees or members to claim an accelerated benefit option for terminal illness life insurance claims.
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Research Proposal Form (For Projects Using CentRIC Datasets)
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A proposal form for researchers seeking to use datasets from the Centre for Psychosocial Research in Cancer (CentRIC+)
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Accessible Parking Form
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Application form for individuals with disabilities seeking an accessible parking permit at Eastern Kentucky University
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Group Accident Insurance Claim Form
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A comprehensive claim form for reporting and documenting accident-related insurance claims with detailed instructions and submission guidelines.
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Accidental Injury Claim Form
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Insurance claim form for documenting details of an accidental injury and related medical information for potential insurance coverage.
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Credit Disability Claim Form
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Instructions for submitting a disability insurance claim for loan protection coverage through American National Insurance Company.
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AccidentIncident Investigation Safety Guidance Document
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A comprehensive safety guidance document outlining procedures for investigating and reporting workplace accidents and incidents, including violent or aggressive events.
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Wenatchee School District Accident Prevention Program
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A comprehensive safety guide for Wenatchee School District employees to prevent workplace accidents and improve occupational safety awareness.
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Club Sports Accident Report Form
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A comprehensive form for documenting sports-related accidents and injuries for recreational sports participants
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Accident Report Form For Non Employees
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A form documenting details of accidents involving non-employees at Chadron State College, used for internal reporting and record-keeping.
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IADT Accident Report Form
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Comprehensive form for documenting workplace accidents, injuries, and subsequent medical treatment with GDPR compliance notice.
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UVU Injury Accident Report Form
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A comprehensive form for documenting injuries and accidents occurring at Utah Valley University for students, employees, and visitors.
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Accident Reporting Procedures
PDF template
Comprehensive guidelines for reporting and managing accidents and injuries on Slippery Rock University campus, including emergency procedures and notification requirements.
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Flamstead Pony Club Accident Reporting Protocol
PDF template
Comprehensive protocol for reporting accidents, injuries, and near misses during pony club activities, including documentation requirements and reporting procedures.
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AccidentIncident Reporting Form
PDF template
Comprehensive guidelines for reporting accidents, incidents, and hazards on university premises, detailing reporting processes and medical response protocols.
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Accident Waiver And Release Of Liability Form
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A legal document that releases event organizers from liability and outlines participant responsibilities for various activities.
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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
PDF template
A legal document that releases event organizers from liability and assumes personal risk for participation in an activity.
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Accident Waiver And Release Of Liability Form
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Legal document releasing event organizers from liability for potential injuries or damages during the White River Dragon Boat Race and Festival.
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Accident Waiver And Release Of Liability Form
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Legal document waiving liability for participants in indoor baseball training activities, releasing the organization from potential injury or damage claims.
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Accident Waiver And Release Of Liability Form
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A legal document releasing the Lupus Foundation of America and event venue from liability for participation in an outdoor movie event.
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BOROUGH OF OAKLAND ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
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A legal document that releases the Borough of Oakland from liability for potential injuries or damages during an event or activity.
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Accident Waiver And Release Of Liability Form
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Legal document releasing Lincoln Academy from liability for potential risks and injuries during summer camp participation.
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Accident Waiver And Release Of Liability Form
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Legal document releasing event organizers from liability for potential injuries or damages during participant's event involvement.
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Accident Waiver And Release Of Liability Form
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Legal document outlining risk acknowledgment and liability release for participation in Swerve Robotics activities and workshops.
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Release And Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement
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A legal document releasing Shiloh Christian School from liability for potential injuries or damages during school activities.
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Accident Waiver And Release Of Liability Form
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A comprehensive legal form releasing liability for various activities and events, covering potential risks and participant responsibilities.
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ACCIDENT WAIVER PDCS 5127a
PDF template
Waiver form for candidates participating in a physical fitness screening test for a civil service position in Suffolk County, NY.
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Accident Waiver And Release Of Liability Form
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A comprehensive liability waiver for parents allowing children to participate in summer art sessions with acknowledgment of potential risks and medical authorization.
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Accident Wellness Benefit Claim Form
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Insurance claim form for submitting wellness screening benefits and personal health information to Guardian Life Insurance.
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Accommodation Request Assessment Form
PDF template
A medical form used to assess an employee's request for workplace accommodation due to disability or pregnancy-related needs.
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Accommodation Inquiry Form
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A form to collect details about research study requirements and preferences for MRI scanning services.
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Accommodations Waiver Form
PDF template
A form for students at Texas Tech University Health Sciences Center El Paso to voluntarily waive existing disability accommodations.
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MEDICAL RELEASE FORM
PDF template
A form granting permission for medical treatment of a student during official academy participation with emergency contact and medical information.
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Waiver Form
PDF template
A consent form allowing the US Department of Health and Human Services to use an individual's image, video, and personal story for promotional purposes.
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Waiver Form
PDF template
A form granting the US Department of Health and Human Services permission to use an individual's photograph, likeness, artwork, profile, or story in various media formats.
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Student Inquiry Form
PDF template
A form for students seeking internships, clinical rotations, and other experiential learning opportunities with the Allegheny County Health Department.
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ACH Pre Authorization Form
PDF template
A form authorizing automatic payment deductions for medical consultations and services from a bank account.
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CLAIM FORM
PDF template
A comprehensive insurance claim form for collecting detailed policyholder and incident information for processing an insurance claim.
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Incident Report Form
PDF template
A comprehensive form for reporting various types of incidents involving staff, members, guests, and program participants at the Abilities Centre.
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Acknowledgement Of Risk And Waiver Of Liability
PDF template
A comprehensive guide for campus departments on using risk and liability waivers for various activities involving physical activity, travel, or minors.
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Activity Participation Waiver
PDF template
A legal document that outlines participant risks and releases the organization from liability during an activity
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Acknowledgment Of Risk And Consent Form
PDF template
Legal document for voluntarily participating in a college activity with acknowledgment of potential risks and liability waiver.
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Patient Medical History Form
PDF template
Comprehensive medical history form for collecting patient health information, symptoms, and medical conditions.
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Medical Information
PDF template
A comprehensive medical form collecting personal health details for emergency preparedness at an event or track setting.
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WAIVER OF AGENCY DUTIES BUYER FORM
PDF template
Legal document detailing fiduciary duties of real estate licensees and potential waivers of certain agency responsibilities.
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HEALTH ASSESSMENT FORM
PDF template
Confidential form for collecting medical history and potential health needs for students planning to study abroad.
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PARENTSTUDENT PHYSICAL ACTIVITY WAIVER FORM
PDF template
A comprehensive waiver form for students participating in physical activities at Christendom College, outlining potential risks and legal protections.
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Activity Participation Waiver Form
PDF template
Legal document that releases Brightpoint Community College from liability for student participation in college activities
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ACTIVITYPROGRAM RELEASE And WAIVER FORM
PDF template
A legal document for releasing liability and obtaining consent for participation in organizational activities or programs.
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Activity Waiver Form (Release, Waiver And Covenant Not To Sue)
PDF template
A legal document that releases Cape Fear Community College from liability for risks associated with participating in an activity or event.
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Naugatuck Valley Activity Waiver Form
PDF template
A comprehensive waiver form for students participating in college-sponsored activities, covering transportation, emergency contacts, and liability release.
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Patient Intake Form Holistic Health Assessment
PDF template
Confidential questionnaire for determining patient treatment plan and collecting comprehensive medical and personal information.
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Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, contact, medical, and insurance information for chiropractic services.
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New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients at Joyanne Kohler Acupuncture, collecting personal and health information.
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Acute Inpatient Hospital Assessment Form
PDF template
Form for requesting authorization for hospital admissions and stay extensions for Blue Cross and Blue Care Network commercial plans
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USDA Program Discrimination Complaint Form
PDF template
Official form for filing a discrimination complaint with the U.S. Department of Agriculture regarding potential discriminatory practices in USDA programs.
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Americans With Disabilities Act Accommodation Request Assessment Form
PDF template
A form for employees to request workplace accommodations under the Americans with Disabilities Act, requiring medical provider documentation of work restrictions or limitations.
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Medical Inquiry Form In Response To An Accommodation Request
PDF template
A medical form used to evaluate an employee's disability and potential workplace accommodations under the Americans with Disabilities Act (ADA).
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Letter Of Recommendation WaiverRequest Form
PDF template
A form for students to request and recommenders to submit confidential letters of recommendation at Harvard University's Adams House.
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DOH 3608 Uninsured Care Programs Medical Eligibility Form
PDF template
A medical form used to determine patient eligibility for HIV-related care programs in New York State
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ADA Program Accessibility Inquiry Form
PDF template
A form for individuals to report accessibility concerns or inquiries related to library programs and services for people with disabilities.
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ADA Job Accommodation Request And Medical Inquiry Form
PDF template
A confidential form to help determine reasonable workplace accommodations for employees with disabilities under ADA guidelines.
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Diagnostic Imaging Referral Form
PDF template
Comprehensive medical imaging request form for various ultrasound, x-ray, and pain therapy procedures with detailed anatomical options.
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Pre Authorization Form Instructions
PDF template
Detailed instructions for completing a medical pre-authorization request form, including required documentation and submission process.
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Medical Form Instructions For TeamSnap
PDF template
Step-by-step guide for team managers to upload player medical forms to TeamSnap profiles
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Required NYS School Health Examination Form
PDF template
A comprehensive health examination form for students in New York State, documenting medical history and current health status
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Additional Shifts Approval Form
PDF template
Form for documenting and approving additional paid shifts for medical residents and fellows beyond their normal program requirements.
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Private Hospitals Discharge Form (ADF96)
PDF template
A comprehensive form for collecting detailed patient discharge data from private hospitals for statistical reporting purposes.
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Vermont Advance Directive For Health Care
PDF template
A legal document allowing individuals to specify their health care preferences and designate a health care decision-maker if they become unable to make decisions for themselves.
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AdjustmentVoid Request Form
PDF template
A form used by healthcare providers to request adjustments or void payments for medical services.
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Volunteer Application And Commitment
PDF template
Comprehensive application for individuals seeking to volunteer with an organization, collecting personal, contact, and availability information.
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Administrative Waiver How To Request Waiver For An Overpayment Under 1000
PDF template
Instructions for requesting an administrative waiver for Social Security overpayments less than $1,000.
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Admission Agreement And Health Assessment
PDF template
Comprehensive form for child enrollment, medical history, emergency contacts, and health assessment for childcare or educational settings.
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ADMISSIONS SUBSTITUTION AND WAIVER FORM
PDF template
Form for requesting course substitutions and waivers for pre-requisite requirements during the admissions process at UTHSC.
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Adobe Generative AI Additional Terms
PDF template
Supplemental legal terms governing the use of Adobe's generative AI features, including guidelines for content input and output.
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Adolescent Vaccination Consent Form (TdapTd, HPV, Meningococcal ACWY)
PDF template
A consent form for parents/guardians to authorize vaccination of adolescents for Tdap/Td, HPV, and Meningococcal ACWY vaccines.
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Hospice Volunteer Application Form
PDF template
A comprehensive application form for individuals interested in becoming hospice volunteers, collecting personal, contact, and background information.
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MINOR PARTICIPANT EMERGENCY CONTACT AND MEDICAL RELEASE FORM
PDF template
A comprehensive form for collecting emergency contact, medical information, and release authorization for a minor participant.
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FMLA Adult Child Disability Medical Inquiry Form
PDF template
A medical form used by the New Mexico Taxation & Revenue Department to determine disability status for FMLA leave to care for an adult child.
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Informed Consent Document Template
PDF template
A template for creating an informed consent document for research study participants explaining study details, procedures, risks, and benefits.
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Girl Scouts Of Greater Los Angeles Adult Emergency Information And Authorization For Treatment
PDF template
Emergency contact and medical authorization form for Girl Scouts of Greater Los Angeles adult participants
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Adult Registration Form
PDF template
A comprehensive form for collecting patient personal and demographic information for healthcare services.
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Adult HIV Confidential Case Report Form
PDF template
Confidential medical reporting form for adult HIV patients in Rhode Island, used for surveillance and epidemiological tracking.
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New Patient Intake Form
PDF template
Comprehensive intake form for new patients to collect personal and medical contact details at a healthcare practice.
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Adult Legal Form
PDF template
A legal form for adult participants in CISV international programs covering medical guardianship, release, and program consent.
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Emergency Medical Form ADULT
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Comprehensive medical authorization and emergency contact form for adult participants in MUMC trips.
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Oklahoma 4 H Youth Development Participant Information Form
PDF template
A comprehensive form for collecting participant health, emergency contact, and medical information for 4-H youth programs and events.
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Adult Confidential Medical Information And Emergency Notification Form
PDF template
Comprehensive medical information and emergency contact form for participants in the 2007 Big Sky Regional Science Bowl
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Adult Medical Release Form
PDF template
Medical and liability release form for participants in Diocese of Little Rock youth ministry events
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Adult Medical Release Form
PDF template
Medical release and consent form for adult participants in environmental education program activities, capturing health information and emergency contact details.
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Adult Specialist Request
PDF template
Medical referral form for requesting an adult specialist appointment with patient and insurance details.
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Adult Registration Form
PDF template
Comprehensive form for collecting patient personal and insurance information for healthcare purposes.
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Community Practice Referral Form Adult Services
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A referral form for occupational therapy and physical therapy services for adult patients with various health conditions and treatment needs.
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Volunteer Application Form
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NDA Adult Volunteer Registration And Waiver Form
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ONE YEAR ADVANCED ENDOSCOPY FELLOWSHIP APPLICATION
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Comprehensive application form for medical professionals seeking a one-year advanced endoscopy fellowship at the University of Missouri's Division of Gastroenterology & Hepatology.
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Provider Appeal Request
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A form for healthcare providers to submit appeals for denied claims or authorizations with Advanced Health.
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Provider Appeal Request
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A form for healthcare providers to request an appeal of a denied claim or authorization with Advanced Health.
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Advanced Illness Benefit Application Form
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Application form for palliative care through the Advanced Illness Benefit for advanced cancer/oncology care by Anglovaal Group Medical Scheme.
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Advance Directive Information Document
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A comprehensive guide explaining advance directives, their purpose, importance, and how to designate a healthcare agent.
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Service Request Form
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Medical form for requesting sleep-related diagnostic services and documenting patient sleep disorder symptoms.
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Medical Information And Physician Release
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A medical form for documenting participant health status and physician clearance for exercise participation at Oregon State University's Adaptive Exercise Clinic.
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AEDBleed Kit Inspection Form
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A comprehensive inspection form for checking the operational readiness and condition of an AED and associated emergency medical supplies.
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Automated External Defibrillator (AED) Post Incident Report Form
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A comprehensive form for documenting events involving the use or attempted use of an Automated External Defibrillator at Middle Georgia State University.
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AED Incident Report Form
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A comprehensive form for documenting and reporting incidents involving the use or attempted use of an Automated External Defibrillator (AED)
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Child Find Referral Form
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Comprehensive referral form for collecting infant/toddler medical and demographic information for early intervention services.
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REFERRAL FORM
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Medical referral form for eye-related consultations and treatments in Edmonton, Alberta.
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Army Emergency Relief Application For Financial Assistance
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Comprehensive application form for military personnel seeking emergency financial support from Army Emergency Relief (AER)
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PATIENT INTAKE FORM
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A comprehensive form for collecting client and pet information for veterinary emergency and specialty care services.
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Prescription Drug Claim Form
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A comprehensive form for submitting prescription drug claims to Aetna Pharmacy Management for reimbursement or processing.
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Covenant Not To Sue And Indemnity Agreement
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Affidavit Of Indigency Form Ohio
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A legal document used to request a waiver of court fees for individuals who cannot afford legal expenses.
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CAA Affiliated Society Membership Form
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Membership form for affiliated societies to join the College Art Association with tiered annual fees based on organization size.
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Active Duty Tour (ADT) Order Request For Military Medical Rotations
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Official form for military personnel to request and document active duty tour assignments for medical rotations
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Accidental Injury Claim Form
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Insurance claim form for documenting details of an accidental injury for potential insurance benefits and reimbursement.
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Continuing Disability Claim Form
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A claim form for filing a continuing disability insurance claim with Aflac, requiring detailed patient and policyholder information.
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Initial Disability Claim Form
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Insurance claim form for reporting disability due to sickness or injury, used by Aflac for processing disability claims.
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M0272B Flexible Spending Account Claim Form
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Form for requesting reimbursement from a Flexible Spending Account for medical and dependent care expenses.
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Initial Disability Claim Form
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Comprehensive form for filing a disability insurance claim covering various types of disability including accidents, sickness, pregnancy, and cancer.
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Sickness Claim Form
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A comprehensive form for filing insurance claims related to sickness, disability, hospitalization, and other health events with Aflac.
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AFSCME Council 5 Grievance Waiver Form
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A form used to officially waive rights to pursue a grievance under a collective bargaining agreement
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After Hours Emergency Contact Form
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Form for businesses to provide contact details and emergency information to local police for property protection during off-hours.
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ADVENTURES IN GOOD COMPANY, INC. ACKNOWLEDGMENT AND ASSUMPTION OF RISKS RELEASE AND INDEMNITY AGREE
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Legal document detailing risks, liability release, and participant responsibilities for Adventures in Good Company travel trips.
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2024 Agency RenewalSurvey Form
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Official form for renewing transport agency licenses for ambulance and stretcher van services in Oklahoma.
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Art Grows Rexburg Children Teen Art Competition Entry Form
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Official entry form for the Art Grows Rexburg art competition for children and teens, detailing submission guidelines and liability terms.
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Services Agreement
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Agreement for individuals to perform data collection tasks for Datoid's AI research and development, involving text, speech, and media labeling and processing.
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Near Miss Hazard And Incident Reporting Guidelines
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Comprehensive guidelines for reporting and managing workplace health and safety incidents, near misses, and hazards within an organization.
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Medical Reimbursement Form
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Form for members to request reimbursement for medical services covered under their health plan
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High Adventure Activity Medical Form
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A medical form for certifying individual fitness for high-risk adventure activities for youth organizations.
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New Patient Intake Form
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Comprehensive medical intake form for new patients seeking plastic, reconstructive, or pediatric head and neck surgical services.
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Instructions For Completion Of Application For Specified Service Authority Allied Health Professiona
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Detailed guidelines for completing an application for medical staff service authority for allied health professionals at Eaton Rapids Medical Center.
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Surgical Booking Request Office Reference Guide
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A guide for completing the Provincial Surgical Booking Request form to facilitate consistent surgical scheduling and resource allocation.
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Arizona Interscholastic Association Annual Preparticipation Physical Evaluation
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A comprehensive medical screening form for student-athletes to assess their health and fitness for sports participation.
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HYPERSENSITIVITY PNEUMONITIS (HP) PANEL
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Medical diagnostic form for testing hypersensitivity pneumonitis and avian panel allergens from the Medical College of Wisconsin.
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PATIENT MEDICAL HISTORY FORM
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Comprehensive medical history form for collecting patient's personal and family health information, past medical conditions, and surgical history.
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Artist Residency Program
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A residency program offering artists from various disciplines an opportunity to pursue their creative practice in a supportive, community-based environment with access to specialized studio facilities.
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AISA Risk Management Program For Local Level Sports
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Comprehensive guidelines for school sports programs focusing on athlete safety, injury prevention, and risk management protocols.
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Patient Intake Form
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A comprehensive form for new patients to provide medical history and contact information for a naturopathic wellness center.
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Advisement And Waiver Of Right To Counsel (Faretta Waiver)
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Resident Assessment
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Comprehensive intake form for documenting a resident's medical history, health status, functional capabilities, and personal information for care facilities.
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Preparticipation Physical Evaluation (Interim Guidance) Physical Examination Form
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A comprehensive medical examination form for athletes to assess physical fitness and health status prior to participation in sports activities.
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Allegations Contained In The StateS Complaint Against Dr. Sun
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Legal document detailing allegations of inappropriate pain medication prescriptions by Dr. Sun for multiple patients with questionable medical necessity.
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Alfred State Workshop AllergyMedical Form
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A comprehensive medical form for documenting a camper's allergies, medical conditions, and emergency contact information.
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Springfield Platteview Community Schools Health Examination Form
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A comprehensive health and immunization form for students in kindergarten through 12th grade in Springfield Platteview Community Schools.
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Allied, Therapeutic And Psychology Extender Benefit Application Form For 2024
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Application form for healthcare benefit coverage under the Retail Medical Scheme's Essential Plus Option for allied, therapeutic, and psychology services.
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CANCELLATION REQUEST FORM
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A form used to request cancellation of medical laboratory tests with detailed documentation requirements.
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Participant Accident WaiverRelease Of Liability Form
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A comprehensive liability waiver for participants in motorcycle events, covering risks, personal fitness, and legal responsibilities.
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Blue Cross Medical Travel Benefit Claim
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A claim form for medical travel expenses for members of the Arrow Lakes Teachers' Association submitted to Pacific Blue Cross.
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Transfer Or Discharge Form
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Special Holiday Waiver For Security Supervisors Unit, Security Services Unit, Or Agency Police Servi
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Form allowing security personnel to choose alternative holiday compensation options for Memorial Day, Veterans' Day, and Independence Day 2023
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AAO HNSF 2022 Annual Meeting OTO Experience Call For Science Submission Guidelines
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Guidelines for submitting scientific presentations to the AAO-HNSF Annual Meeting, including eligibility requirements and speaker responsibilities.
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Nomination For An AMA Award
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Official form for nominating medical professionals for various American Medical Association awards and recognitions.
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All Musicians Club And Musicians Performance Studio Club Membership Form
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Membership application and liability waiver for the All Musicians Club and Musicians Performance Studio Club for Laguna Woods Village residents and guests
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MultiCare Auburn Medical Center PGY1 Pharmacy Residency Application Information
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Application instructions and requirements for PGY1 pharmacy residency at MultiCare Auburn Medical Center
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AM Club And Extra Innings Payment Agreement
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Payment agreement for school year programs offered by Homewood-Flossmoor Park District, covering AM Club and Extra Innings programs.
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Medical Examination Report For Bus Transit System Driver
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Comprehensive medical examination form for bus transit system drivers to assess health conditions and fitness for duty.
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AMERICAN CLUB PRE EMPLOYMENT MEDICAL EXAMINATION FORM2019
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Comprehensive medical examination form for seafarer pre-employment screening with multiple medical tests and assessments.
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RES Reunification Registration Form
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A form to help individuals register as safe during a disaster and assist in family reunification efforts by the American Red Cross.
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Dental Claim Form
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A comprehensive form for submitting dental insurance claims, requiring patient and employee information, treatment details, and authorization signatures.
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AMG At Home Admission Check
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Comprehensive admission checklist and information for patients interested in AMG Senior Medical Group's at-home medical services.
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AMG Requisition Form
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A form used by surgeons to request amniotic membrane grafts (AMG) from Ramayamma International Eye Bank.
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AMI Insurance Application
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A comprehensive insurance application form for personal health coverage with options for individual or family plans.
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Student Health Examination Form
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Medical examination form for students, documenting health history, physical examination, and immunization status.
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Individual Volunteer Registration AgreementTime Record
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Registration and time tracking form for volunteers at the Department of Natural Resources in Washington State
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RD AN No. 4694 (4274 D And 1951 R)
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Administrative notice providing clarification and guidance for Intermediary Relending Program (IRP) processing and servicing requirements.
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Angeles New Waiver Forms FAQ
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Comprehensive guide explaining the Sierra Club's new Participation Agreement, its purpose, usage, and implementation details.
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Animal Incident Report Form
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A detailed form for reporting animal-related incidents involving bites, scratches, or other exposures to an animal.
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MAD Artists Residency Application Form
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Application form for artists seeking residency at MAD studio space for January-March 2024 period.
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Activity Based Risk Assessment Form
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A comprehensive form for identifying, evaluating, and controlling workplace safety hazards and risks.
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Annual Health Evaluation Form
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A comprehensive health evaluation form for tracking medical history, lifestyle factors, and current health status.
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Answer And Waiver
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Legal document in which a respondent acknowledges a divorce petition, waives service of process, and agrees to the petition's terms.
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Member Claim Form
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Insurance claim form for submitting medical expenses and service details to Anthem Blue Cross health insurance.
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Medical Insurance Claim Form
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A standard medical insurance claim form for submitting patient information and medical service details to an insurance provider.
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Medical Claim Form
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A comprehensive medical claim form for submitting healthcare service details and patient information to Anthem Blue Cross insurance.
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Medical Claim Form
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A comprehensive form for submitting medical insurance claims, collecting patient, subscriber, and medical service information.
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Medical Claim Form
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A comprehensive medical claim form for submitting healthcare service reimbursement claims to Anthem Blue Cross and Blue Shield insurance.
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Medical Claim Form
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A standard medical insurance form for submitting healthcare service claims and patient information to an insurance provider.
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Waiver Of The Service Of Summons
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Legal document allowing a defendant to waive formal service of a summons in a civil court action, simplifying legal notification process.
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AO 399 Waiver Of The Service Of Summons
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Legal document allowing a defendant to waive formal service of a summons in a civil court action, reducing service expenses.
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AO Alliance (AOA) ORP Fellowship Application Form
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Application form for medical professionals seeking a fellowship with the AO Alliance in orthopedic and trauma surgery
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AO Alliance (AOA) Surgeon Fellowship Application Form
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Application form for surgeons seeking a fellowship with the AO Alliance, requiring detailed professional and personal information.
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Assumption Of The Risk And Hold Harmless Agreement
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Legal document outlining risk assumption and liability waiver for contractors working in a fraternity chapter facility.
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Notice Of Voluntary Resignation Form
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Release And Waiver Of Liability Form
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Liability waiver for students enrolled in De Anza College's adapted swimming courses, outlining participation requirements and risk assumptions.
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PARTICIPANT MEDICAL HISTORY FORM
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Confidential medical history form for collecting participant health information for trips and activities by APEX
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Medical Information Release Form
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A form allowing parents or legal guardians to specify who can receive medical information about their child from Angelina Pediatrics, PLLC.
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Prescription Transfer Request Form
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A form for transferring prescription medications between pharmacies at the University of Colorado Health Center.
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Tuberculosis Case Management Manual
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A comprehensive manual providing guidelines, resources, and forms for tuberculosis case management in Missouri.
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Appendix 5 Medical Release Form
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A medical release form for seniors participating in the Community Healthy Activities Model Program, allowing notification of primary care physician.
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NSW Health UndertakingDeclaration Form
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Form for health workers and students to declare compliance with infectious disease screening and vaccination requirements for NSW Health facilities.
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RELEASE, WAIVER OF LIABILITY, COVENANT NOT TO SUE
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Legal document releasing Columbus State University from liability for potential injuries during a camp or conference event.
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Business Growth Accelerator (BGA) Proposed Program Budget Form
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A detailed budget form for program income, funding sources, and expenditures for the Business Growth Accelerator program.
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Appendix C Sample Letter To Parents
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Informational letter to parents about free H1N1 flu vaccination for students at a school-based clinic.
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Safety Shower And Eye Wash Inspection Form
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Guidelines for weekly inspection and maintenance of emergency eyewash and safety shower stations to ensure proper functionality and safety.
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NAPNAP Faculty Declaration Form
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A form for presenters to declare potential financial conflicts of interest and off-label drug or medical device discussions.
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Appendix T San Diego Police Department Crime Laboratory Feedback Form
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A detailed evaluation form for forensic evidence collection and assessment during a medical forensic examination.
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11F ApplicantS Waiver Form (Collegiate Only)
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A form for collegiate applicants to waive providing information to their parents/guardians during the sorority membership intake process.
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Charitable Trust Of The Auckland Faculty Royal New Zealand College Of General Practitioners Applicat
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Comprehensive assessment form for evaluating research grant applications from general practitioners in New Zealand.
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APPLICATION FEE WAIVER FORM
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Form to request waiver of civil service examination application fees for unemployed individuals or those receiving public assistance.
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Application For Credit By Examination
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Official form for students seeking to earn academic credits through examination in the Department of Languages and Literatures of Europe and the Americas.
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ARTIST RESIDENCY APPLICATION FORM
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Application form for artists seeking residency opportunities at coGalleries in Berlin, Nairobi, or Beijing.
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FHNO Institutional Fellowship Application Form
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Application form for fellowship in Head and Neck Oncology/Reconstructive Surgery with comprehensive applicant details collection.
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APPLICATION FOR MILITARY SKILLS TEST WAIVER
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Form for qualified service members to apply for a Commercial Driver License (CDL) waiver based on military vehicle operation experience.
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APPLIED LEARNING STUDENT EVALUATION FORM
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A comprehensive form for students to provide detailed feedback about an educational program or learning experience.
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Medical Appeals And Reinstatements Sections 717273
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Comprehensive guide for NYC employees seeking medical reinstatement, detailing required documentation and submission procedures.
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STUDENT INCIDENT REPORT FORM
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A comprehensive form for documenting student incidents, including details of the event, student's account, and additional comments from faculty or preceptors.
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Functional Medicine Clinic Appointment Time Agreement
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Agreement outlining fees and policies for patient appointments, including no-show and late cancellation charges.
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Course Waiver Form
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A form allowing students to request exceptions to standard course enrollment requirements such as prerequisites, class restrictions, and time conflicts.
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Observation And Interview Research Instruments
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A set of research forms for collecting qualitative data about artists' creative processes through observation, interviews, and document analysis.
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Teacher Program Agreement Media Release Form
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A document for teachers participating in UCLA's AP Readiness Program, including program commitment and media release consent.
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Aquatics Cancellation Form
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A form for withdrawing from YMCA aquatics classes with refund and payment policy details.
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OCCUPATIONAL MEDICAL SURVEILLANCE PROGRAM PHYSICAL EXAMINATION FORM
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A comprehensive medical examination form for documenting employee health status and physical condition for the United States Department of Agriculture.
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ARC Disaster Requisition Form 6409
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A form used to request resources and services during disaster response and recovery operations.
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Remdesivir Prescribing DeclarationStreamlined IPU Application Form
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A form for healthcare professionals to request and prescribe Remdesivir for COVID-19 patients meeting specific criteria.
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Arizona SPDSCLUE Waiver Form
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A form allowing buyers and sellers to waive property disclosure statement and insurance claims history report in a real estate transaction.
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Legacy Tuition Waiver Form
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A form allowing non-resident students to receive resident tuition rates if a family member graduated from Wichita State University.
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Army Physical Training Risk Assessment Example
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A document detailing risk assessment techniques for military physical fitness training and potential health considerations for soldiers.
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Sunday Studio Art 101 Classes Registration Form
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Registration and medical consent form for art classes for children ages 10-15 at the Art Gallery of Guelph.
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Sunday Studio Art 101 Classes Registration Form
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Registration and consent form for children's art classes at the Art Gallery of Guelph, including class selection, medical information, and emergency contacts.
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Pictures Of John Gray Art Competition Entry Form
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An entry form for an art competition related to the Pictures of John Gray project by Codpiece Theatre
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Contribution Form
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A donation form for contributing to various scholarships and programs within the Emporia State University Art Department.
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EvCC Articulation Request Checklist For CTE Dual Credit Program
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A form for high schools to request articulation or update existing articulation for Career and Technical Education (CTE) dual credit courses with Everett Community College.
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Artist Agreement
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Legal agreement outlining terms between an artist and Cedar Gallery for artwork exhibition, sales, and promotional use.
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Submission Usage Agreement With The Art Of Autism Website And Affiliated Sites, Social Media And New
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A legal agreement for artists submitting artwork to The Art of Autism, outlining usage permissions and submission guidelines.
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Art Service Scholarship Form
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Scholarship application for students pursuing art as a major at ECCC with specific service requirements and academic criteria.
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Art Service Scholarship Form
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A scholarship application form for students interested in pursuing art as a major at E.C.C.C. with specific eligibility and service requirements.
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MMB Insurance Form
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A form for documenting artwork details and insurance values for an art exhibition by the Madison Arts Commission.
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Math And Science Prerequisite Waiver Form
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Form for students seeking to waive math and science course prerequisites at Macomb Community College
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4th Annual Art Event Submission Guidelines
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An art event raising mental health awareness through creative submissions from artists with mental health service experience in Maryland.
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Westlake Porter Public Library ArtWalk Submission Form
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Guidelines and submission form for community art display at Westlake Porter Public Library's ArtWalk program for local artists.
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Alexandria Soccer Association Medical Release Form
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A medical authorization form allowing team officials to obtain medical attention for a child during soccer activities.
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Consent Form For Participation In A Research Study
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Informed consent document for a research study involving a stressful computer task with potentially disturbing visual stimuli.
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Central Registry Referral Form
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A referral form for documenting spinal cord injury or disability cases for the Arkansas Spinal Cord Commission's central registry.
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ICARUS MEDICAL, LLC ORDER FORM
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Order form for custom knee braces with patient and measurement information.
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Referral Form
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Medical referral form for new patient intake and treatment evaluation at Ascend Health Center, focusing on mental health services.
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Assumption Of Risk, Waiver, Release And Indemnity Agreement
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Legal document outlining risks and liability for participation in various recreational activities at the Anne Springs Close Greenway.
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ASE Organizational Membership Application
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Organizational membership application for multiple members from the same institution to join or renew ASE membership with various professional categories and pricing tiers.
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ASE Membership Application Form
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Organizational membership application form for joining or renewing membership in the American Society of Echocardiography with various membership categories and pricing.
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Liability Waiver Form For ASF Members
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A legal document waiving liability for children participating in activities at Scandinavia House Children's Center and authorizing emergency medical treatment.
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ASIIS Enrollment Application
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Application for organizations to enroll in the Arizona State Immunization Information System (ASIIS) for healthcare providers and facilities.
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MEDICALVISION CLAIM FORM
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A comprehensive claim form for submitting medical and vision insurance claims, requiring detailed employee and patient information.
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Asthma Assessment Form For School
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Comprehensive form to collect detailed medical information about a student's asthma symptoms, triggers, and management for Seattle Public Schools.
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Athlete Emergency Contact Form
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A form for collecting student athlete emergency contact details and medical conditions for use by school athletic department personnel.
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Special Olympics Medical Form
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Comprehensive medical form for Special Olympics athletes documenting health history, conditions, and participation details.
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Special Olympics Medical Form
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Medical examination form for determining an athlete's fitness to participate in Special Olympics sports programs, requiring medical professional evaluation.
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Athletic Emergency Contact Form
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A comprehensive form collecting medical, contact, and emergency information for student athletes.
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Melba Schools Activity Policy
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Comprehensive policy document covering insurance waiver, drug testing consent, and activity participation guidelines for Melba School District students.
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Athletic Travel Form
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A comprehensive form for student-athletes detailing emergency contact information, medical details, and consent for medical treatment during athletic participation.
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Adobe Training Provider Program Agreement
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Legal agreement defining terms and conditions for membership in Adobe's Training Provider Program, including benefits and eligibility requirements.
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MedicalForensic Examination Form
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A detailed forensic medical examination form for documenting physical findings in sexual assault cases, covering body diagrams and genital examination for both female and male patients.
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Waiver Service Request Form (DP 1022)
PDF template
A form for requesting changes or new services in a waiver program, to be completed when team concurrence is not achieved.
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Bishop Canevin Attendance Notice
PDF template
Official school document for recording student absences, tardiness, early dismissals, and medical appointments.
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Instructions For TrainersLeaders Completing The Attendance Forms
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Detailed guide for completing an attendance tracking form for a training program, specifying how to record participant demographics and participation details.
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MINOR YOUTH EMERGENCY MEDICAL CONTACT, HEALTH HISTORY AND TREATMENT AUTHORIZATION
PDF template
A comprehensive medical contact and health authorization form for minors participating in a program, collecting emergency contacts, health information, and parental consent for medical treatment.
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Attending PhysicianS Compliance Form
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Medical form documenting physician compliance and patient consent for end-of-life medication request in the District of Columbia.
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Long Term Disability Claim Form
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A comprehensive medical form for documenting a patient's disability claim, including medical history, diagnosis, treatment, and current condition.
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West Kentucky ATV Recreational Area Release And Waiver Of Liability And Indemnity Agreement
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Legal document releasing liability for participants entering and using the West Kentucky ATV Recreational Area for off-highway vehicle riding.
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New Academic Program Proposal Form
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A comprehensive form for proposing new academic programs at Fitchburg State University, detailing program specifics, requirements, and implementation plans.
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Consent To Use Sound And Image Recordings That May Contain Identifying Information For Education
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A consent form allowing physicians to use patient images and sound recordings for educational purposes with patient's understanding of potential identification.
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IHS Diabetes Care And Outcomes Audit, 2024
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A comprehensive audit form for tracking diabetes patient health metrics, screenings, and examinations
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Patient Intake Form
PDF template
Comprehensive patient intake form for collecting personal, contact, and medical insurance information at Auburn University Clinical Health Services clinics.
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Universal Service Request Form
PDF template
Form for comprehensive employee medical examinations, drug testing, and workplace health screening documentation.
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HOLD HARMLESS, VOLUNTARY WAIVER, AND ASSUMPTION OF RISK FORM
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A legal document that releases Auburn University from liability for potential injuries or damages during a field trip event.
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WaiverAuthorization Form
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A legal liability waiver for participants in Keep Florence Beautiful community activities and events.
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Williamson County Schools Procedure Authorization Form
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A form for authorizing medical procedures to be administered to a student during school hours, requiring physician and parental consent.
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HIV Related Information Release Authorization Form
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Legal form authorizing release of medical and HIV-related information under New York State confidentiality laws
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Authorship Agreement Form
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A form documenting individual contributions and authorship criteria for academic or medical research publications.
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Autism Emergency Contact Form
PDF template
A comprehensive emergency contact and personal information form for individuals with autism, designed to assist in case of emergencies or potential wandering incidents.
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Autism Emergency Contact Form
PDF template
A comprehensive form collecting critical personal and medical information for individuals with autism in case of emergency or potential wandering incidents.
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Autism Profile And Emergency Contact Form
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A comprehensive form for documenting critical medical, contact, and behavioral information for individuals with autism
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New PIP Patient Form
PDF template
Detailed form for documenting vehicle accident details and patient information for insurance or medical purposes.
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Avera EConsult Assessment Form
PDF template
A comprehensive medical assessment form for telemedicine patient consultations, capturing patient information and physical examination details.
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Project Authorization Request (PAR)
PDF template
Project Authorization Request for modifying an existing IEEE standard related to local and metropolitan area network virtual bridged local area networks.
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Animal Workers Medical Surveillance Consent For Medical ScreeningEvaluation
PDF template
A consent form for medical screening and evaluation of individuals working with animals at the University of Idaho.
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Medical Expense Claim Form
PDF template
A form for employees to claim medical expenses through a Flexible Spending Account with detailed submission instructions.
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Alfond Youth Community Center New England Sports Camps Medical History Form 2023
PDF template
Comprehensive medical history and emergency contact form for children attending various sports camps in Maine.
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Patient Authorization Form
PDF template
A form authorizing AstraZeneca to use and share patient health information for support services and coordination of care.
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Member Request For Medical Reimbursement Form
PDF template
A form used by UnitedHealthcare Community Plan members to request reimbursement for medical services, co-payments, coinsurance, and deductibles.
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Comptroller General Decision B 156482
PDF template
Official decision denying a former government employee's request to waive salary overpayments due to an erroneous personnel record.
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Build America, Buy America Act (BABAA) Domestic Content Procurement Preference Requirements Waiver
PDF template
A form for requesting a waiver from the Build America, Buy America Act domestic content procurement preference requirements for U.S. Department of Education grants.
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My Choice Wisconsin BadgerCare Plus Authorization Form
PDF template
A comprehensive form for requesting healthcare service authorizations under the BadgerCare Plus program in Wisconsin.
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Laurel High School Marching Band Medical Form
PDF template
Medical form for Laurel High School Marching Band students to provide health and emergency contact information for band activities.
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Medical History Form
PDF template
A comprehensive medical history form for collecting student health information, emergency contacts, and family medical history.
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Bangs Ambulance Events Request Form
PDF template
Form for requesting ambulance and medical support services for events with specific scheduling details.
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Chronic Appliance Benefit Application Form
PDF template
Medical application form for patients seeking insurance coverage for chronic medical appliances and equipment through Bankmed.
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Medical History Form
PDF template
Comprehensive medical history form for patients seeking weight loss treatment, collecting personal, medical, and insurance information.
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Health Is Wealth Patient Intake Form
PDF template
Comprehensive medical intake form collecting patient personal, employment, emergency contact, and insurance information.
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Baseball Medical Release Form
PDF template
A medical authorization and consent form for baseball participants, allowing medical treatment and acknowledging potential risks of participation.
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Health Care Personnel (HCP) Baseline Individual TB Risk Assessment
PDF template
A screening form to assess tuberculosis risk factors for healthcare personnel through a series of yes/no questions about travel, immunosuppression, and TB exposure.
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Westlake Charter School BASE Program Registration Packet
PDF template
Registration packet for Westlake Charter School's before and after school program, providing details and required forms for student enrollment.
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St. Ignatius Basketball Camp Liability Waiver Form
PDF template
Liability waiver and emergency contact form for participation in St. Ignatius Basketball Camp for student-athletes.
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ACHD Bathing Place Incident Report Form
PDF template
A comprehensive form for reporting incidents and injuries at public bathing facilities, including water rescues and medical treatments.
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Incident Report Procedure
PDF template
A comprehensive procedure for managing and reporting incidents involving Best Buddies members, volunteers, and staff, focusing on safety and proper response protocols.
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Liability Media Release Form
PDF template
A release form for parents/guardians to authorize child participation in music school programs and grant media usage permissions.
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BC3NP Enrollment Form
PDF template
Healthcare enrollment form for collecting patient contact, demographic, and service needs information.
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Sport Injury Accident Report Form
PDF template
A comprehensive form for documenting sports-related injuries or accidents during an event, capturing details about the injured person and medical response.
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Patient Insurance Information Form
PDF template
Comprehensive form for collecting patient medical insurance and health coverage details for claims processing.
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Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for documenting medical treatment, injury, or preventive care for reimbursement purposes.
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Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient details, treatment information, and other coverage details.
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Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for submitting medical treatment claims with detailed patient and treatment information.
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Educators Health Alliance Medical And Dental Enrollment Form
PDF template
A medical and dental insurance enrollment form for Educators Health Alliance, allowing new applications and changes to existing coverage.
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Member Reimbursement
PDF template
A form for members to request reimbursement for healthcare expenses paid out-of-pocket directly to providers.
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SNFAcute IPR Assessment Form
PDF template
Prior authorization form for skilled nursing facility and inpatient rehabilitation services for Blue Cross Blue Shield of Michigan and Blue Care Network providers.
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Member Reimbursement
PDF template
A form for Blue Cross Blue Shield members to request reimbursement for healthcare expenses paid out of pocket.
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Medical Expense Claim
PDF template
A claim form for submitting medical expenses to Blue Cross and Blue Shield of Alabama for reimbursement.
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Member Reimbursement
PDF template
Form for members to request reimbursement for healthcare expenses paid out-of-pocket.
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Member Claim Form
PDF template
A form for filing healthcare claims with Blue Cross Blue Shield of North Carolina, detailing patient and insurance information for reimbursement of medical services.
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Western Carolina University Base Camp Cullowhee Health And Medical Form
PDF template
A health screening form for participants in outdoor activities, collecting medical history and emergency contact information.
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My Benefit Plan Summary
PDF template
Comprehensive health benefits summary for full-time employees of Brant Community Healthcare System through Green Shield Canada.
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ADPH F BCL 136 Alabama Department Of Public Health (ADPH) Bureau Of Clinical Laboratories (BCL) Requ
PDF template
A comprehensive laboratory testing request form used by healthcare providers to submit patient specimens for clinical testing in Alabama.
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Member Billing Form
PDF template
A form for submitting medical bills from non-participating healthcare providers for reimbursement or claim processing.
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Member Reimbursement Form
PDF template
A form for healthcare members to request reimbursement for out-of-pocket medical expenses they have paid directly.
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MEDICAL INFORMATION FORM
PDF template
A comprehensive medical form for participants of outdoor adventure trips, collecting health, emergency, and medical history information.
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Participant Agreement
PDF template
Agreement detailing COVID-19 safety protocols and participant responsibilities for Ringette BC club activities and Team BC athletes.
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BDIAP Glasgow 2020 Educational Fellowship Application Form B
PDF template
Application form for medical or scientific professionals seeking an educational fellowship with the British Division of the IAP in Glasgow
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Physical Examination Form
PDF template
A comprehensive medical form for documenting a student's physical health assessment by a healthcare provider.
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Ancillary Order Form
PDF template
A medical form for ordering orthotic services, therapy, and documenting patient diagnostic information.
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MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal information, medical history, insurance details, and current health status.
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M NCPPC BENEFITS ENROLLMENTCHANGE FORM
PDF template
Form for employees to enroll or change benefits, covering medical, dental, and prescription plans for new hires or those experiencing qualifying life events.
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Benefits Cancellation Form
PDF template
Form for employees to cancel or modify health, dental, and life insurance benefits with Haverhill Public Schools.
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Informed Consent, Voluntary Waiver, Release Of Liability, Assumption Of Risk, And Photography Releas
PDF template
Legal document for parental consent and liability release for child participation in a program at Bethel University
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Bachelor Of Fine Arts Application Form
PDF template
Application form for students seeking admission to the Bachelor of Fine Arts program at the University of Nevada, Reno.
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Bachelor Of Fine Arts (BFA) Application Form
PDF template
Application form for students seeking admission to the Bachelor of Fine Arts degree program with concentration selection and approval process.
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Bachelor Of Fine Arts Application Form
PDF template
A comprehensive guide for students applying to the Bachelor of Fine Arts program, detailing admission requirements, application process, and program expectations.
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BOISE FIRE DEPARTMENT MEDICAL RELEASE FORM
PDF template
Medical form for evaluating and releasing firefighters to full duty after injury or medical assessment.
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Health Savings Account Transfer Request Form
PDF template
A form for transferring health savings account assets from a previous trustee/custodian to Benefitfocus Account Services HSA.
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BGCC Program Refund Request
PDF template
A form for parents to request a refund for a BGCC (Boys & Girls Club of America) program participation
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Discharge Form
PDF template
A form used to document and track patient discharge details for behavioral health clinical services.
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Patient Medical History Form
PDF template
Comprehensive medical history form collecting patient's personal health information, medical history, symptoms, and current health status.
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FederalDOT Testing Form
PDF template
Comprehensive medical screening and drug testing form for transportation workers requiring federal agency compliance.
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BIIS Participant Registration Form
PDF template
Registration form for athletes with physical disabilities to participate in Bridge II Sports programs and activities.
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Disaster Survivors Fairness Act Of 2022
PDF template
Legislation to enhance individual assistance and information sharing for disaster survivors through FEMA and federal agencies.
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BIMA Bash Auction Procurement Form 2023
PDF template
A form for artists to donate artwork or experiences for the Bainbridge Island Museum of Art's 10th Anniversary fundraising auction.
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Histology Service Request Form
PDF template
A form for requesting histology services including tissue processing, embedding, staining, and immunohistochemistry for human or animal biospecimens.
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UH IBC Biological Laboratory Incident Report Form
PDF template
A comprehensive form for reporting biological incidents, injuries, or near misses in a laboratory setting, requiring documentation within 24 hours.
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Oncology Prescription Referral Form
PDF template
A comprehensive form for submitting oncology patient prescription details, insurance information, and clinical data for medication authorization.
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Patient Intake Form
PDF template
Comprehensive medical form for collecting patient personal, contact, medical, and insurance information with consent authorization.
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Harvard University Biosafety Manual
PDF template
Comprehensive guide for laboratory safety protocols, biosafety levels, and procedures for handling biological materials at Harvard University.
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Release And Assumption Of Risk Form
PDF template
Legal document releasing the Bermuda Institute of Ocean Sciences from liability during scientific, research, or recreational activities.
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Medication Order Form
PDF template
A comprehensive form for patients to provide medical information, contact preferences, and medication order details for Birdi pharmacy services.
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Emergency Contact Form
PDF template
A form for collecting and updating emergency contact information for students in the Berne-Knox-Westerlo Central School District.
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BL 2 Laboratory Inspection Form
PDF template
A comprehensive safety inspection form for biological laboratories, focusing on biosafety level 2 (BL-2) requirements and protocols.
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Exhibition Proposal Form
PDF template
A form for students to propose and submit details for an art exhibition at a university gallery.
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Arts In Corrections MONTHLY ATTENDANCE SHEET FY 20 21
PDF template
Attendance tracking form for arts programs in correctional facilities, documenting participant attendance and class details.
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Credit Card Pre Authorization Form
PDF template
A form authorizing The Viva Center to charge credit card for services with pre-approved billing parameters.
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Design Competition Entry Form 2024
PDF template
A form for participants to submit creative badge design entries for a competition organized by Pawprint Family.
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PATIENT INTAKE FORM
PDF template
Comprehensive medical intake form for collecting patient health information, medical history, and current health status.
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Official Travel Request Form
PDF template
Comprehensive travel request form for participants, volunteers, and staff to provide travel details and personal information for a trip.
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Blood Body Fluid Exposure Report
PDF template
A form documenting blood or body fluid exposure incidents for students, tracking medical testing and follow-up procedures.
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Blood Drive
PDF template
Blood donation drive organized by American Red Cross at Mt. San Antonio College to collect blood donations.
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TEST REQUEST
PDF template
A comprehensive medical test request form for collecting patient information and specifying various laboratory tests to be performed.
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Health Insurance Claim Form
PDF template
Comprehensive form for collecting patient medical insurance information, health coverage details, and claim submission details.
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Blue Cross Blue Shield Insurance Claim Form
PDF template
A comprehensive medical insurance claim form for collecting patient and insurance information for medical service reimbursement.
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Member Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service expenses to Anthem Blue Cross insurance.
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Enrollment And Change Form
PDF template
Healthcare insurance enrollment and change form for selecting medical and dental coverage options through Blue Cross Blue Shield
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Santa Monica College Confidential Medical History
PDF template
A comprehensive medical history form for students to document personal health information and medical background.
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Sul Ross State University Bacterial Meningitis Vaccination Compliance Form
PDF template
Mandatory form for students to demonstrate compliance with bacterial meningitis vaccination requirements for university enrollment.
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Bert Miller Nature Club Waiver
PDF template
Annual waiver form for Bert Miller Nature Club members and guests to acknowledge risk and provide emergency contact information.
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Application For Skills Test Waiver Military Exception
PDF template
A form allowing qualified military service members to apply for a Commercial Driver License (CDL) without skills testing under specific conditions.
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Application For Skills Test Waiver Military Exception
PDF template
A form allowing military service members to apply for a Commercial Driver License (CDL) waiver based on their military vehicle operation experience.
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Bomb Threat Assessment Form
PDF template
A detailed form for documenting and assessing information received during a potential bomb threat phone call or notice.
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Bomb Threat Checklist Form
PDF template
A standardized form for documenting details during a potential bomb threat telephone call to assist law enforcement and security personnel.
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Termination Of Membership Form
PDF template
A form for members to officially resign from the Bonitas Medical Fund and terminate their medical scheme membership.
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F0008 BOOKING FORM
PDF template
A comprehensive form for registering participants for a training course, including individual and employer details, payment information, and terms and conditions.
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Book Order Form
PDF template
Order form for a commemorative book about the Michigan Society of Thoracic and Cardiovascular Surgeons' history.
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Ventura County Wellness Program Waiver Form
PDF template
A waiver form for voluntary participation in a county wellness fitness program, detailing recreational activity liability and health considerations.
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Academic Degree Program Proposal Form
PDF template
A form for proposing and documenting new academic degree programs with institutional and accreditation details.
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BostonSight (HIPAA) MEDICAL RECORDS RELEASE FORM
PDF template
A form that allows patients to grant permission for BostonSight to share their medical information with specified individuals or organizations.
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Suspect Foodborne Or Unknown Etiology Botulism Case Interview Form
PDF template
A detailed medical form for collecting comprehensive information about a potential botulism case, including patient demographics, clinical information, and medical history.
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Suspect Foodborne Or Unknown Etiology Botulism Case Interview Form
PDF template
A detailed medical form for collecting comprehensive information about a potential botulism case, including patient demographics, clinical information, and medical history.
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License Authorization Form
PDF template
A form for medical facilities to authorize product ordering and certify licensing for prescription drugs, medical devices, and controlled substances.
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Camp Medical Form
PDF template
A medical form for parents/guardians to provide health information and medical history for children attending summer camp.
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AMWA Branch Annual Report Form
PDF template
Annual reporting form for branches of the American Medical Women's Association to document branch activities and leadership
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RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
PDF template
Legal document for releasing liability and obtaining consent for YMCA program participation and activities.
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BRASSEl Pilar Program Medical Form
PDF template
Confidential medical history form for participants in an archaeological research program at El Pilar, collecting personal health information and emergency contact details.
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Patient Medical Referral Form
PDF template
Comprehensive medical referral form capturing patient demographics, diagnostic information, and key health metrics
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Patient Intake Form
PDF template
Comprehensive form for collecting patient and family medical contact information for pediatric medical practice.
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BRYC Elite Academy Medical Release Form
PDF template
A medical consent form allowing treatment for a youth athlete in case of injury or medical emergency during sports activities.
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Informed Consent, Release Agreement, And Authorization
PDF template
A comprehensive consent and medical authorization document for participating in Scouting activities, covering emergency medical treatment and risk acknowledgment.
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Emergency Action Plan (EAP)
PDF template
A comprehensive guide for coaches to prepare and respond to emergency situations during practices and competitions.
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JOINT BSMS DEGREE PROGRAM AUDIT FORM
PDF template
A form for students to document their eligibility and plan for a combined bachelor's and master's degree program at FAU.
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LOEWENBERG SCHOOL OF NURSING HEALTH EXAMINATION FORM (FORM 003)
PDF template
Comprehensive health history and screening form for nursing students to document medical background and potential health concerns.
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Waiver Application Form
PDF template
Application for local educational agencies seeking to reopen elementary schools for in-person instruction during COVID-19 pandemic.
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REQUISITION FORM
PDF template
A form for patient information, billing details, and physician consent for medical testing by BillionToOne.
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2015 Creative Art Competition Entry Form
PDF template
Entry form for an art competition addressing the theme of breaking the silence on child sexual abuse
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Budget Form Training To Competence Externship
PDF template
A budget form for applicants seeking funding for an externship program, requiring detailed expense documentation and submission at least one month prior to start date.
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F. BUDGET FORM
PDF template
Budget form detailing income and expenses for a teen mentoring program, including funding request from the Sisters of Charity Foundation.
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Budget Form Reproductive Health Externship Clinical Abortion Observation
PDF template
A form for medical students to document and request funding for expenses related to a reproductive health externship or clinical abortion observation program.
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Building Department Emergency Contact Form
PDF template
Contact form for capturing emergency and routine contact details for local building departments and inspectors
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BUILDING HEALTH AND SAFETY RISK ASSESSMENT FORM
PDF template
A comprehensive form for identifying and assessing potential hazards and risks in a building environment.
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QuarterlyMonthly Building Inspection Form
PDF template
A comprehensive safety inspection form covering fire safety, emergency equipment, and building safety conditions.
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BuildOn Medical Form
PDF template
A comprehensive medical form for participants traveling to do physical labor in a remote community, focusing on detailed health history and potential medical risks.
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Proper Use Of The Official Waiver Of Standards Form
PDF template
A guide explaining the use of the Official Waiver of Standards Form for termite treatments in South Carolina, detailing regulatory changes and requirements.
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Accident Waiver And Release Of Liability Form And Photo Release
PDF template
Legal document waiving liability for participants in a recreational event, covering potential risks and injuries.
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COPPERAS COVE POLICE DEPARTMENT BUSINESS CONTACT FORM
PDF template
Form for collecting business contact information to be used by local police in emergency situations
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Business Emergency Contact Form
PDF template
A form for businesses to provide emergency contact details to local police for potential security and emergency response purposes.
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Genesee County SheriffS Office Business Contact Information Form
PDF template
A comprehensive form for collecting business location, contact, and emergency response details for the Genesee County Sheriff's Office.
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Business Directory Contact Form
PDF template
A form for businesses to provide emergency contact information to local public safety departments in Jonesborough, Tennessee.
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Business Emergency Contact Form
PDF template
A form for businesses to provide emergency contact details and key holder information for city and dispatch purposes.
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Business Emergency Contact Form
PDF template
A form for local businesses to provide emergency contact and security information to the police department.
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Business Emergency Contact Form
PDF template
Form for businesses to provide emergency contact and hazardous materials information to local law enforcement.
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Prime Contractor Waiver Form
PDF template
A form for contractors to document their business equity commitment and subcontractor/supplier usage for City of Fort Worth projects.
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Business Residence Contact Information
PDF template
A form for collecting contact details for businesses and residences in Bedford Hills, NY for police department records.
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Business Security Contact Form
PDF template
A form for collecting business contact and security information for local police department records.
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BUS TRIP OVERNIGHT MEDICAL RELEASE FORM
PDF template
Medical and contact information form for student campus visit, including health insurance and emergency contact details.
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Play At Own Risk Waiver And Participant Consent To Treat Form
PDF template
Legal waiver and medical consent form for participants in a regional basketball championship tournament
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Physical Examination Form For Driver Applicant
PDF template
Medical evaluation form for assessing a driver's physical fitness, particularly for school bus drivers in Florida.
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AccidentIncident Investigation Recording Policy
PDF template
A comprehensive policy for recording, investigating, and reporting accidents, incidents, and near misses within an educational trust.
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CADRE PROPOSAL FORM
PDF template
A form for faculty and staff to propose and submit a cadre program for review by University Ministries.
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WEST VIRGINIA WESLEYAN COLLEGE CAFETERIA PLAN MEDICAL CARE EXPENSE CLAIM FORM
PDF template
A form for submitting medical expense reimbursement claims under a cafeteria plan with detailed certification and documentation requirements.
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ResidencyFellowship Non ERAS Common Application Form
PDF template
Comprehensive application form for medical residency and fellowship programs at the University of Connecticut School of Medicine
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CALLIGRAM COMPETITION 2024
PDF template
An artistic competition for students to create visual text art (calligrams) themed around classroom objects and scenes.
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Certificate Declaration Form
PDF template
Form for students declaring a certificate program at Mississippi State University's College of Agriculture and Life Sciences (CALS)
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PatientS Information Form
PDF template
Comprehensive medical form for collecting patient personal, contact, insurance, and healthcare provider information.
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Camp Card Drive For 25 Achiever
PDF template
Tracking form for scouts participating in the Camp Card "Drive for 25" fundraising program
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Camp Dina Medical Form PhysicianS Page
PDF template
Medical form for physician documentation required for camp enrollment and health tracking.
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Camp Potlatch 2020 Medical Form
PDF template
A comprehensive medical form for parents/guardians to provide health information for children attending Camp Potlatch summer camp.
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Camp LMU Registration, Informed Consent, Student Medical Release Form
PDF template
A comprehensive registration form for Camp LMU that collects camper personal information, emergency contacts, medical details, and photo release consent.
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NYC Summer Camp Permitting Application Guidance
PDF template
Official guidance from NYC Health Department for summer camp operators detailing permit application requirements and COVID-19 related protocols for 2022.
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Camp Potlatch 2022 Medical Form
PDF template
A comprehensive medical form for parents to provide health details about their child attending Camp Potlatch summer camp.
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Duquesne University Campus Residency Waiver Request
PDF template
A university form allowing students to request exemption from mandatory campus housing requirements.
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New Consultation Referral Form
PDF template
Medical referral form for new patient consultation at an oncology clinic, collecting patient diagnosis, referral details, and medical history.
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Cancer Claim Form
PDF template
Claim form for filing a cancer-related insurance claim with Aflac New York, requiring policyholder and patient details along with medical documentation.
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Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient health history, contact information, and current medical status.
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CLAIM FORM AND INSTRUCTIONS
PDF template
A comprehensive insurance claim form for filing wellness exam benefits with instructions for submission and processing.
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CANINE EXPORT SUBMISSION FORM
PDF template
A veterinary diagnostic laboratory form for submitting canine export health testing and documentation for international animal transportation.
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CANINE SUBMISSION FORM
PDF template
Legal form for submitting veterinary diagnostic specimens to Kansas State Veterinary Diagnostic Laboratory with billing and specimen information.
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CAOS Fellowship Application Form
PDF template
An application form for medical professionals seeking a fellowship in computer-assisted orthopaedic surgery with the International Society for Computer Assisted Orthopaedic Surgery.
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Standardized Application For Pathology Fellowships
PDF template
A comprehensive fellowship application form for pathology residency candidates covering personal, educational, and training details.
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MEDICAL HISTORY FORM
PDF template
A comprehensive form for patients to provide detailed medical information relevant to dental treatment and health assessment.
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Release Of Information Authorization Form
PDF template
A form authorizing Counseling and Psychological Services (CAPS) to release protected clinical information to designated persons or agencies.
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Standardized Application For Pathology Fellowships
PDF template
Comprehensive application form for medical professionals seeking specialized pathology fellowship training across various subspecialties.
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Standardized Application For Pathology Fellowships
PDF template
Official application form for pathology fellowship candidates, covering personal information, education, and fellowship specialization preferences.
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Standardized Application For Pathology Fellowships
PDF template
Comprehensive application form for medical professionals seeking specialized fellowship training in various pathology subspecialties.
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Capital Access Program (CAP) Notice And Waiver Form
PDF template
A formal document outlining borrower acknowledgment and waiver for participation in the Capital Access Program loan enrollment process.
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FMLA InformationRequest Packet
PDF template
Comprehensive packet of forms and instructions for employees requesting Family and Medical Leave Act (FMLA) leave through Carbon County HR.
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Youth Sports League Roster Waiver
PDF template
A comprehensive form for youth sports team registration, including player and guardian contact information and liability release.
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Care Coordination Referral Form
PDF template
A form for requesting care coordination assistance for members with various health and support needs
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Caregiver Consent Act Affidavit
PDF template
An official form allowing non-guardian caregivers to consent to medical treatment for minors under specific circumstances in West Virginia.
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CAREGIVER CONTACT FORM
PDF template
A form for patients to provide details about a designated caregiver who can be contacted regarding their medical care and treatment.
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Caregiver Medical History Form
PDF template
A medical history form for caregivers to provide health background information for TNT staff review
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CaregiverS Authorization Affidavit
PDF template
A legal document authorizing a caregiver to enroll a minor in school, access medical care, and educational records
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Pre Authorisation Form Care
PDF template
A detailed medical insurance form for patients seeking cashless hospitalization, capturing personal, medical, and insurance details.
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Care Management Referral Form
PDF template
A referral form for recommending patients with complex medical or behavioral health conditions to care management programs.
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Mail Service Order Form
PDF template
A form for ordering prescriptions through mail service with health history and participant information collection.
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Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims with detailed patient and insurance information requirements.
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Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider or healthcare plan.
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CASE EVALUATION FORM
PDF template
A comprehensive medical assessment form for evaluating patient seating needs and physical condition using a BRODA chair.
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Family Law Case Participant Enrollment Form (Party)
PDF template
A form for enrolling in online case access system for family law cases in Sacramento County Superior Court
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Consent Form For Case Reports
PDF template
A consent form for patients to authorize publication of medical information in journals or theses while maintaining patient anonymity.
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CASL Medical Release Form
PDF template
A comprehensive medical release and liability waiver form for soccer players, allowing medical treatment and releasing organizations from liability.
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Medical History Form
PDF template
A comprehensive form for collecting medical information about a student's health conditions, medications, allergies, and parental consent for over-the-counter medication.
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Casualty Assessment Form
PDF template
Comprehensive medical assessment form for documenting patient condition, injuries, and treatment details.
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Risk Assessment Policy And Procedures
PDF template
A comprehensive policy for managing and conducting risk assessments within the Community Academies Trust, outlining processes, types of risk assessment, and regulatory compliance.
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Catalog Declaration Form
PDF template
A form for students to declare or update their academic program catalog term and requirements at Oregon State University-Cascades.
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Catalog Declaration Form
PDF template
A form for students to update their academic catalog year when adding new majors or minors not available during their initial enrollment.
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Catastrophic Sick Leave Request Form
PDF template
A form for employees to request catastrophic sick leave due to extended illness or injury as defined by Alabama state law.
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Animal Patient Medical Record
PDF template
Comprehensive medical intake form for documenting a veterinary patient's health status and physical examination details.
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Patient Medical Information Form
PDF template
Comprehensive medical intake and tracking form for patient demographics, facility details, and medical specimen information.
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MONTREAT COLLEGE ATHLETIC DEPARTMENT SPORT PREPARTICIPATION EXAMINATION FORM
PDF template
A comprehensive medical screening form for college athletes to assess health conditions and potential risks before sports participation.
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WAIVER FORM
PDF template
A legal form allowing corporate officers, directors, general partners, and LLC managing members to opt out of workers' compensation insurance coverage in California.
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I Voted Sticker Contest
PDF template
A contest for York County students in grades K-12 to design an official 'I Voted!' sticker for local elections.
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Program Health And Waiver Form
PDF template
A comprehensive health and emergency contact form for program participants to provide medical information and consent for field station activities.
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CCCC Medical Sonography Program Volunteer Informed Consent
PDF template
Consent form for volunteer scan models participating in medical sonography student training at Central Carolina Community College.
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Student Activity Travel General Release And Waiver Of Liability
PDF template
Legal document releasing Calhoun Community College from liability during student activity travel events.
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Backflow Incident Report Form
PDF template
A form for reporting water system backflow incidents, detailing contamination sources, effects, and corrective actions.
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Backflow Incident Report Form
PDF template
A form for reporting water supply contamination incidents involving backflow, used to document details of potential water quality hazards.
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Emergency InformationUpdate Form
PDF template
A comprehensive form for collecting child's emergency contact, medical, and parental information for YMCA child care programs
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Liability Waiver And Release Form (Minor Child)
PDF template
A legal document releasing the Chesterfield County Fair from liability for minor children participating in volunteer activities at the fairgrounds.
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New Patient Intake Patient Medical History
PDF template
Comprehensive medical intake form for new patients collecting detailed personal and health information.
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Post Disaster Self Assessment Form For Early Childhood Programs
PDF template
A guidance tool to help child care providers assess safety hazards and environmental risks after a disaster before reopening their facilities.
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Pediatric Care Management Referral Form
PDF template
A comprehensive referral form for children aged 0-20 years to access care management and coordination services.
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Volunteer Form
PDF template
A comprehensive form for individuals interested in volunteering, collecting personal information and including liability waivers and consent agreements.
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MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal information, medical history, lifestyle details, and emergency contacts.
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Cottonwood Crossing Summer Institute Health Information Form
PDF template
A comprehensive medical form for student participation in summer institute activities, collecting health insurance, medical history, and emergency treatment authorization.
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Personal Vehicle Travel Liability And Insurance Form
PDF template
A liability release form for students using personal vehicles for university-sponsored off-campus activities
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CDC 50.42A Adult HIV Confidential Case Report
PDF template
Comprehensive medical reporting form for documenting HIV cases for patients over 13 years of age, used by health departments and CDC for surveillance purposes.
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Authorization For Release Of Information
PDF template
A form authorizing the Federal Motor Carrier Safety Administration to disclose medical records related to a commercial vehicle operator's medical exemption application.
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Commonwealth Of Dominica Physical Examination Report
PDF template
A comprehensive medical screening form for seafarers detailing personal and medical history
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Pre Employment Medical Form
PDF template
Comprehensive medical assessment form for pre-employment screening including medical history, vital signs, and tuberculosis screening.
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COVID 19 VACCINE CONSENT FORM
PDF template
Comprehensive consent form for receiving COVID-19 vaccination, collecting patient medical information and screening for potential vaccine contraindications.
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CDPHP Co Pay Reimbursement Form
PDF template
Form for employees to submit medical co-pay expenses for reimbursement through Hudson Valley Community College's healthcare program.
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Celiac Disease Diagnostic Testing Requisition Form
PDF template
Medical form for ordering celiac disease diagnostic tests, including patient and prescriber information and insurance details.
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PATIENT REGISTRATION MEDICAL HISTORY FORM
PDF template
Comprehensive medical registration form for patient intake, collecting personal, contact, and insurance information for medical services.
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VCU RCDI G CENC External Concussion Diagnostic Interview
PDF template
A medical interview form for documenting potential concussive events and detailed injury information
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Patient Referral Form
PDF template
A comprehensive healthcare referral document for patient intake, medical assessment, and service selection.
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Application For Waiver Of Probate Bond
PDF template
Legal document for estate representatives to request waiver of probate bond and provide estate details
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MEDICAL RELEASE FORM
PDF template
A legal form allowing medical treatment for a minor in the absence of a parent or guardian, including consent for medical procedures and documentation of medical history.
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Emergency Exam Cancellation Form
PDF template
Form for clinical research professionals to request fee waiver for exam cancellations due to emergencies or extenuating circumstances.
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Certification Of Need And Waiver Of Liability (Prescription Delivery)
PDF template
A form for patients without transportation to receive prescription medication delivery, including liability release and risk assumption.
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CESS IncidentEmergency Management Initial Point Of Contact Form
PDF template
A form used to document initial details of an emergency or incident involving students, faculty, or staff.
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MEDICAL FORM
PDF template
Confidential medical history form for collecting patient personal and health information for medical examination purposes.
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Daily Waiver Form
PDF template
Comprehensive waiver form for participants of Wilmette Park District Fitness Center, covering injury risks, medical treatment, and photography consent.
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Consent Form Checklist For Reliance On External IRBs
PDF template
Guidance for UCLA investigators creating site-specific consent forms when relying on external Institutional Review Board (IRB) approval.
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Candia Farmers Market Accident Waiver And Release Of Liability Form
PDF template
Legal document releasing Candia Farmers Market from liability for potential accidents or injuries during market participation.
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OCCUPATIONAL MEDICAL HISTORY AND EXAMINATION FORM
PDF template
A comprehensive medical examination form for U.S. Coast Guard employees covering personal and occupational health information and potential workplace exposures.
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International Group Travel Release
PDF template
Legal release document for participants in international group travel programs, outlining risks and liability waivers for Claremont Graduate University programs.
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Accident Investigation Appendix C Resources
PDF template
Guide for reporting and documenting workplace accidents, incidents, and injuries at Portland Community College
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MEDICAL INFORMATION AND RELEASE FORM
PDF template
A comprehensive medical form for participants in Hartwick College Challenge Programs, collecting health information and liability acknowledgment.
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CHAMP Assessment Medical History Form
PDF template
Comprehensive medical history form for fitness assessment program, collecting health and exercise background information from participants.
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Change Of Use Request
PDF template
A process for evaluating and approving changes in commercial facility use and determining septic system adequacy in Indiana.
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2020 States 4 H OB Medical Form (Non Japan)
PDF template
Medical evaluation form for chaperones participating in a cross-cultural exchange program, assessing health status and medical conditions.
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Release Of Liability, Acknowledgement Of Risk And Acceptance Of Responsibility
PDF template
Legal document waiving liability for risks associated with participating in a Community Corrections Chase event.
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Safety Inspection Form For Chemistry Laboratory, Chem CU
PDF template
A comprehensive safety inspection form for evaluating laboratory safety protocols, equipment, and documentation requirements.
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NEW PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting new patient personal, contact, and medical information for a medical practice.
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Health Care Provider Exam Form
PDF template
A comprehensive medical examination form for tracking patient vaccinations, health status, and provider details.
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Immunization And Health Assessment Form
PDF template
Medical form documenting vaccination history, physical exam status, and healthcare recommendations for children.
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Idaho Conditional Attendance To Childcare Schedule Of Intended Immunizations Form
PDF template
A form documenting the intended immunization schedule for children not fully vaccinated at childcare admission
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Child Care General Health Examination Form
PDF template
A health examination form for children entering child care programs, documenting their general health status and medical information.
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Child Care General Health Examination Form
PDF template
A medical form documenting a child's health status and conditions for child care program enrollment.
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Child Care General Health Examination Form
PDF template
A medical form documenting a child's health status and conditions for child care enrollment.
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Child Comprehensive Medical Release Permission Form
PDF template
Medical release and permission form for children participating in parish or diocesan activities, capturing health information, emergency contacts, and medical history.
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Application For Child Life Internship
PDF template
Application guidelines and requirements for internship positions at Children's Hospitals and Clinics of Minnesota's Child Life Department.
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Child Patient Intake Form
PDF template
Comprehensive intake form for children with cancer, collecting patient and family information for Rock Cancer Care services.
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Child Registration Form
PDF template
A comprehensive form for registering a child, collecting personal and insurance information for medical or childcare purposes.
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MEDICAL And LIABILITIES RELEASE FORM
PDF template
A comprehensive form for medical information and liability release for children participating in church activities and programs.
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MEDICAL HISTORY CHILD
PDF template
Comprehensive medical history questionnaire for collecting pediatric health information and previous medical conditions.
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Calvary Baptist Church ChildrenS Ministry Participant Permission Medical Release
PDF template
A comprehensive permission and medical release form for children participating in Calvary Baptist Church ministry activities during 2024.
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Child Travelling Alone Legal Form
PDF template
Legal form for parents/guardians authorizing solo travel for 16-17 year old participants in CISV international programs with medical consent and release provisions.
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Health Information Form
PDF template
Confidential health information form for participants in an international research program between Alabama A&M University and Nanjing Forestry University.
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STUDENT HEALTH FORM
PDF template
Comprehensive health form for students to provide medical information and health status to an educational institution
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Department Of RadiologyImaging Services Pre Scheduling Evaluation Form
PDF template
Medical form used by physicians to request and evaluate imaging services, including patient details and medical history for CT or MRI scans.
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CLIENT REQUISITION FORM
PDF template
A comprehensive medical test requisition form for various health diagnostics including inflammation, lipids, metabolic, and other specialized tests.
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Chronic Illness Benefit Application Form
PDF template
An application form for patients seeking chronic illness benefits through the Glencore Medical Scheme, detailing submission requirements and contact information.
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Chronic Medical Condition Treatment Compliance Form
PDF template
Form documenting a patient's ongoing medical treatment and compliance with care standards for at least 6 months
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CIEF Membership Form 2019 2020
PDF template
Membership form for competing and non-competing members of a sports or equestrian organization
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Cigna Claim Form (Rev. 72015)
PDF template
A comprehensive form for submitting healthcare service reimbursement claims with patient, provider, and payment information.
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Medical Claim Form
PDF template
Form for submitting medical claims for fellows, trainees, and patients seeking international health insurance reimbursement.
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TEST REQUISITION FORM
PDF template
A laboratory test request form for clinical immunodiagnostic testing with patient and specimen information collection fields.
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Application Form Travel Fellowship
PDF template
Application form for academic travel fellowship to support research related to Spanish art and culture.
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Food Inspection Form
PDF template
Official form used by the Environmental Health Department to conduct food safety inspections of commercial food establishments.
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Notice Of Lawsuit And Request For Waiver Of Service Of Summons
PDF template
A legal document requesting waiver of formal service of summons in a civil legal proceeding to reduce service costs.
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Waiver Of Service Of Summons
PDF template
Legal document allowing a defendant to waive formal service of court summons to reduce legal processing costs.
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2021 CIVME Research Grant Program Grant Application Instructions
PDF template
Instructions and guidelines for applying to the Council on International Veterinary Medical Education research grant program.
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AIA Miami CKLDP Agreement Form
PDF template
Participation agreement for the AIA Miami Leadership Development Program detailing attendance requirements and participant commitments.
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Military Medical Intake And Deployment Assessment Form
PDF template
Comprehensive medical assessment form for active duty military personnel covering health status, deployment readiness, and substance abuse screening.
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Waiver Service Request Form
PDF template
Form for requesting driver assessment and training services for rehabilitation clients with potential adaptive driving needs.
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MEDICAL EXPENSE CLAIM
PDF template
Form for filing medical expense claims with Blue Cross and Blue Shield of Alabama when a healthcare provider does not file a claim directly.
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CIEE Claim Form
PDF template
A comprehensive medical claim form for student health insurance reimbursement and documentation of medical conditions or treatments.
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Dental Insurance Claim Form
PDF template
Insurance claim form for submitting dental treatment and patient information for reimbursement or coverage verification.
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Student Insurance Claim Form
PDF template
Insurance claim form for students to report medical examinations, illnesses, prescriptions, or injuries for insurance coverage.
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Claim Form Finder And User Guide
PDF template
Comprehensive guide to help healthcare providers select the appropriate claim form for various submission scenarios and corrections.
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Claim Form Finder
PDF template
Comprehensive guide for healthcare providers detailing claim modification forms and processes for Neighborhood Health Plan of Rhode Island.
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Details Of Hospital Claim Form Part B
PDF template
A comprehensive medical claim form for documenting patient hospital admission, treatment, and insurance claim details.
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Member Reimbursement Form For Medical Claims
PDF template
A form for patients to submit medical claims for reimbursement, detailing patient, subscriber, and provider information.
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Claims Reimbursement Form
PDF template
A comprehensive form for submitting medical claims for reimbursement, used by patients or healthcare providers to request payment for medical services.
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Employee Information Checklist
PDF template
A comprehensive checklist evaluating workplace safety, ergonomics, fire safety, electrical safety, and workstation conditions for employees.
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Student Class Evaluation
PDF template
An evaluation form for students to provide feedback on educational programs and instructors in emergency medical services.
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Hermitage Visual Arts School Class Proposal Form
PDF template
A form for instructors to propose and detail a visual arts class at the Hermitage Museum & Gardens Visual Arts School.
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Class Waiver Form
PDF template
A form to request waiving a certification class requirement in the MSBO Voluntary Certification Program based on existing credentials or experience.
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PacificSource Enrollment Application
PDF template
A comprehensive group health insurance enrollment form for employees and their dependents to select medical and dental coverage.
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Patient Information Form
PDF template
Comprehensive patient intake form collecting personal, contact, medical, and insurance information for dermatology services.
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Student Confidential Contact Form
PDF template
A form allowing students to designate a confidential contact person in compliance with the Higher Education Opportunity Act of 2008.
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Cancer Services Client Intake Form
PDF template
Confidential intake form for cancer patients seeking free services in Erie, Huron, and Ottawa counties in Ohio.
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Cancer Services Client Intake Form
PDF template
Comprehensive intake form for cancer patients seeking free support services, collecting personal, medical, and financial information.
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CLIMBucknell MEDICAL FORM
PDF template
Medical history and emergency contact form for participants in a university climbing/ropes course activity
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Accident Waiver And Release Of Liability
PDF template
A comprehensive legal document releasing event organizers from liability for potential injuries or damages during an athletic event.
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CLINICAL BOOKING FORM
PDF template
A form for scheduling telehealth consultations and televisitation events for healthcare professionals.
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Behavioral Health Discharge Clinical Form
PDF template
A clinical form for documenting patient discharge details from behavioral health treatment, including care level, residence, and follow-up appointments.
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Clinical Incident Report Form 4.3
PDF template
A form documenting details of a clinical incident, including injury, location, witnesses, and actions taken.
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Nephrology Laboratory Test Requisition
PDF template
A clinical form for requesting laboratory tests related to complement system and nephrology research at Cincinnati Children's Hospital.
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HARKNESS CENTER FOR DANCE INJURIES PATIENT MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form specifically designed for documenting dance-related injuries across multiple body regions.
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Clubs Emergency Contact Information
PDF template
School emergency contact and medical information form for recording student and parent contact details and health information.
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Notice Of Field Trip And Waiver Of Liability
PDF template
A legal document for students participating in a voluntary field trip, requiring a signed waiver of liability by the participant.
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Club Sports Informed Consent Form
PDF template
A legal consent and liability release form for students participating in club sports at Connecticut College, acknowledging risks and insurance responsibilities.
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Club Travel Emergency Contact Form
PDF template
A form for documenting emergency contact details for students participating in off-campus college trips.
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Medical History Form
PDF template
Comprehensive medical history form collecting patient's personal health details, family medical history, and lifestyle information.
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Population Assessment Of Tobacco And Health (PATH) Study Parent Consent And Permission For Youth Int
PDF template
A consent form for parents to allow their children aged 12-17 to participate in a national tobacco and health research study.
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Request For Waiver Form
PDF template
Official form for medical assistants to request a waiver for certification exam eligibility due to criminal history or professional license issues.
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Health And Emergency Contact Form
PDF template
A comprehensive form for collecting student medical history, emergency contact details, and healthcare consent at Central Maine Community College.
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PATIENT MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form for collecting patient demographic, family medical history, and personal health information.
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Centers For Medicare And Medicaid Services EDI Registration Form
PDF template
A registration form for healthcare providers to establish electronic data interchange (EDI) capabilities with the Centers for Medicare and Medicaid Services.
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Centers For Medicare And Medicaid Services EDI Registration Form
PDF template
Form for healthcare providers to register for Electronic Data Interchange (EDI) transactions with Centers for Medicare and Medicaid Services.
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Form CMS 116 (0324)
PDF template
Clinical Laboratory Improvement Amendments (CLIA) certification application for health laboratories seeking federal certification.
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HEALTH INSURANCE CLAIM FORM
PDF template
Standard medical insurance form for submitting healthcare claims and patient information for reimbursement purposes.
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Health Insurance Claim Form
PDF template
Official form for submitting medical insurance claims and capturing patient and insured party information.
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CMSP 215 Supplemental Application
PDF template
Application form for individuals seeking medical services coverage through the County Medical Services Program with rights and responsibilities outlined.
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CN 28 Application For Waiver
PDF template
Instructions and form for requesting a waiver from New Jersey Department of Health licensing standards for healthcare facilities.
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Adult Medical History Form
PDF template
Comprehensive medical history form for collecting patient health information, symptoms, and medical conditions.
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Infant Medical History Form
PDF template
Comprehensive medical history form for pediatric patients covering medical tests, therapies, medications, developmental milestones, and birth history.
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CNHS Insurance Requirements Proof Of Health Insurance Form
PDF template
Form for documenting student health insurance coverage for clinical and practicum rotations in the College of Nursing & Health Sciences.
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Curriculum Approval Form
PDF template
A comprehensive form for proposing, reviewing, and approving academic program changes at a university.
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CNS User Fee Waiver Form
PDF template
A form to request waiver of user fees when a CNS facility or tool malfunctions during a scheduled reservation.
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Conservation Northwest Field Volunteer Waiver Form
PDF template
A legal waiver form for volunteers participating in wildlife monitoring and conservation field work with Conservation Northwest.
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Conservation Northwest Field Volunteer Waiver Form
PDF template
A legal waiver form for volunteers participating in wildlife monitoring and outdoor conservation projects with Conservation Northwest.
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SPORT CLUB COACHES MEMBERSHIP FORM
PDF template
Form for coaches to apply for membership and participation in university recreational sports programs with liability waiver and approval process.
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COVID 19 Code Of Conduct And Waiver Form Addendum
PDF template
Guidelines and requirements for participant forms and safety protocols for Special Olympics Washington during the Summer Season
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College Of Education And Health Professions ACCIDENTINCIDENT REPORT
PDF template
A comprehensive form for documenting accidents, injuries, and incidents within the College of Education and Health Professions.
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Referral Form
PDF template
A form for healthcare providers to request patient referrals and provide medical background information.
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Athletics Drug Education And Testing Student Athletes
PDF template
Policy for drug education and testing of student athletes in the Alabama Community College Conference, focusing on health, safety, and fair competition.
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College Sponsored Related Medical And Travel Form
PDF template
A medical and travel authorization form for students participating in college-sponsored activities with COVID-19 compliance and liability waiver provisions.
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Camp Medical Form, College Tennis Exposure Camp
PDF template
Medical form for participants of a college tennis exposure camp, capturing health history and emergency contact information.
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COLOGUARD ORDER REQUISITION FORM
PDF template
Medical order form for Cologuard, a stool-based DNA test used for colorectal cancer screening
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COLOGUARD ORDER REQUISITION FORM
PDF template
Medical order form for Cologuard, a stool-based DNA test for colorectal cancer screening
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Insurance Claim Processing Instructions
PDF template
Instructions for submitting an insurance claim, including required documentation and processing details for Colonial Life & Accident Insurance Company.
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New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients to collect personal, contact, and health information for medical providers.
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AFI PRE AUTHORIZATION FORM FOR HOSPITALIZATION FROM PANEL NON PANEL HOSPITALS
PDF template
A form for obtaining pre-authorization for hospitalization from panel and non-panel hospitals for insurance coverage.
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Combined Safety Inspection Form
PDF template
A comprehensive safety inspection checklist for laboratory environments at Dartmouth College to ensure compliance with safety protocols and regulations.
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NEW PATIENT REGISTRATION FORM
PDF template
Comprehensive form for new patient medical registration, including personal information, medical history, insurance details, and a physician-patient arbitration agreement.
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Commercial Electric Customer Deferred Payment Agreement
PDF template
A utility agreement allowing commercial customers to defer electric service payments during the COVID-19 public health emergency
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BFA Committee Declaration Form
PDF template
A form for BFA students to declare their faculty committee members at the University of Nevada Reno's Department of Art
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Pre Professional Evaluation Waiver Form
PDF template
A form allowing students to choose whether to waive or retain access rights to their recommendation letters for professional school applications.
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Common Child And Adolescent Psychiatry Application
PDF template
An application form and procedure guide for medical professionals seeking child and adolescent psychiatry residency programs.
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ResidencyFellowship Non ERAS Common Application Form
PDF template
Comprehensive application form for medical residency and fellowship candidates seeking placement at the University of Connecticut School of Medicine.
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Standardized Application For Pathology Fellowships
PDF template
A comprehensive application form for medical professionals seeking pathology fellowship training in various subspecialties.
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Communicable Disease Report For Healthcare Providers
PDF template
A comprehensive medical reporting form for healthcare providers to document communicable disease cases in Arizona.
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Marquette University ComMUnity Physical Therapy Clinic Referral Form
PDF template
A referral form for patients seeking physical therapy services at Marquette University's Community Physical Therapy Clinic.
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Community Membership Form
PDF template
A medical history and liability waiver form for campus recreation membership at Lees-McRae College, requiring personal and medical information along with a hold harmless agreement.
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Wellness Community Membership Form
PDF template
Form for enrolling in NEO Wellness community membership with health information and policy acknowledgment.
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Health Care Provider Complaint Form
PDF template
Official form for filing a complaint against a healthcare provider in Florida with detailed information requirements for investigation.
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Complaint Report
PDF template
A form for submitting complaints to the local health department, allowing individuals to report health or nuisance-related issues.
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USDA Program Discrimination Complaint Form Instructions
PDF template
Instructions for filing a discrimination complaint with the United States Department of Agriculture (USDA) regarding program discrimination.
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Complaint Report Form
PDF template
Form for reporting patient complaints and potential protected health information disclosure at UW-Milwaukee
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The Wellness Plan ComplaintResolution Form
PDF template
A form for documenting patient complaints, concerns, and their resolution within a medical center's wellness plan.
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STEPSFORMS TO SEE DR. SENIOR
PDF template
Detailed guidelines for students seeking to schedule and attend a psychiatric appointment with Dr. Senior at Landmark College.
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Emergency Contact Form
PDF template
A form for students to provide emergency contact details and medical authorization for University of Detroit Mercy.
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Comprehensive Pain Assessment Form
PDF template
A detailed form for evaluating and documenting a patient's pain characteristics, intensity, and management goals.
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COM Prepaid Visa Card SOP
PDF template
Standard operating procedure for requesting and processing prepaid Visa cards for research participant compensation at the University of South Alabama College of Medicine.
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Authorization For Examination Or Treatment
PDF template
A medical authorization form for workplace-related medical examinations, testing, and treatment with comprehensive patient and service details.
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Concussion Incident Form
PDF template
A form for documenting and reporting concussion-related incidents in sports, specifically for Ringette Canada.
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Concussion Recovery Teacher Feedback Form
PDF template
A form for teachers to provide feedback on a student's post-concussion academic performance and symptoms.
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Concussion Waiver Form
PDF template
A waiver form requiring student athletes to acknowledge and report concussion symptoms to medical staff.
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Concussion Waiver Form
PDF template
A waiver form for student athletes acknowledging their responsibility to report concussion symptoms and potential injuries.
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Concussion Waiver Form
PDF template
A waiver form requiring student athletes to acknowledge their responsibility in reporting concussion symptoms and understanding concussion risks.
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Montana Newborn Screening Program Condition Nomination Form
PDF template
A form used by healthcare professionals to nominate new medical conditions for inclusion in Montana's newborn screening panel.
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Confidential Contact Form For Students Residing At Hague Club Apartments
PDF template
Form allowing students to register a confidential contact who will be notified if the student is reported missing.
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Confidential Medical History Form
PDF template
Comprehensive medical symptoms and conditions checklist for patient intake, covering multiple body systems and health concerns.
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Environmental Health Safety Policy
PDF template
Policy addressing safety procedures and requirements for entering confined spaces at Connecticut College, following OSHA guidelines.
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An Artistic Discovery Art Competition Exhibit Inventory Form
PDF template
Form for submitting artwork entries for Congressman Bill Posey's FL-8th Congressional District Art Competition with a Space Program theme.
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Metal Bracelet DNR Purchase Form
PDF template
A form for ordering metal DNR identification bracelets in Connecticut for patients with a Do Not Resuscitate order.
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CONSENT INSURANCE FORM
PDF template
A comprehensive form for collecting medical insurance and consent information for a cadet or applicant, including parent/guardian details and insurance policy information.
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Participant Consent Form
PDF template
A consent form for participants of a workshop, explaining survey data collection and potential Medicare study participation.
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Adult Consent Form
PDF template
A comprehensive medical consent form for adults, collecting personal information and health history details prior to medical treatment or vaccination.
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Child Consent Form
PDF template
A comprehensive health screening form for children to assess medical history and vaccination readiness.
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ATTACHMENT ADULT CONSENT FORM (EXAMPLE)
PDF template
Research consent form for a study exploring participants' experiences related to child abuse and religious contexts.
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Consent Form ImPACT Baseline Concussion Testing
PDF template
A consent form for participating in baseline concussion testing for student-athletes in Montgomery County Public Schools.
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Utah State Board Of Education ParentGuardian Consent Form Maturation Instruction
PDF template
A parental consent form for students participating in puberty and reproductive health education classes in Utah schools.
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Consent For Publication Form
PDF template
A form granting permission for personal information or medical details to be published in a journal or article while acknowledging potential public exposure.
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Consent To Treat Form
PDF template
Parental consent form for chiropractic evaluation and treatment of a child, with specific limitations on diagnostic scope.
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Consent For Treatment
PDF template
Comprehensive patient consent document covering treatment, benefits assignment, privacy practices, and telemedicine consent for Kentucky Cardiology medical services.
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Authorization For Medical Treatment Of Child
PDF template
A form allowing school representatives to consent to medical treatment for a student when parents cannot be reached during an emergency.
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Providence Mountain Emergency Services Consent To Treat Form
PDF template
Medical release and emergency treatment authorization form for participants in Providence Mountain program from December to May.
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Consent To Treat Release Form
PDF template
A form authorizing Woodward School to secure medical treatment for a student in emergency situations when parents cannot be immediately contacted.
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ParentGuardian Authorization For Regular Extracurricular Travel And Consent To Emergency Treatment O
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A school district form authorizing student participation in extracurricular activities and providing emergency medical consent.
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USA Hockey National Championships Consent To TreatMedical History Form
PDF template
A comprehensive medical history and consent to treat form for USA Hockey participants, covering emergency contact, medical history, and insurance information.
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CONSENT TO TREAT MINOR CHILDREN
PDF template
A legal form allowing parents or guardians to provide medical treatment consent for a minor child when the parent is not immediately available.
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USA Hockey National Championships Consent To TreatMedical History Form
PDF template
Medical consent and history form for USA Hockey participants, allowing medical treatment and collecting health information for emergency purposes.
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Medical Release Form (For Students Under The Age Of 18)
PDF template
A consent form allowing medical treatment for students under 18 when parents/guardians cannot be immediately contacted.
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CONSENT, WAIVER, RELEASE AND INDEMNITY AGREEMENT
PDF template
A legal document outlining participant consent, risk assumption, and liability waiver for a university program or activity.
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Consent, Waiver, Release And Indemnity Agreement
PDF template
Legal document outlining participant consent, risk assumption, and liability waiver for international medical exchange programs.
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Pathology Consult Request Form
PDF template
A form for requesting pathology consultation and case review between medical institutions.
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Contact Information And Medical Form
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A comprehensive medical form collecting participant's personal information, emergency contacts, medical history, and health conditions for University of Maine at Presque Isle program participation.
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Environmental Health And Safety Contractor Incident Report
PDF template
A comprehensive form documenting workplace incidents, injuries, and safety-related events for contractors.
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Contract Request Form (CRF)
PDF template
Form for healthcare providers to request a contract and credentialing with Molina Healthcare
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McLaren Flint Foundation Contribution Form
PDF template
Fundraising form for making charitable donations to McLaren Flint Foundation with multiple designated giving options.
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Annual Controlled Substance Inventory Form
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A form for tracking and documenting annual physical inventory of controlled substances as required by state and federal regulations.
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Curatorial Opportunity Program (COP) Guidelines
PDF template
Guidelines for independent curators to submit group exhibition proposals for the New Art Center's Main Gallery from September 2018 to May 2019.
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New Art Center Curatorial Opportunity Program (COP) Guidelines
PDF template
Guidelines for submitting group exhibition proposals for the New Art Center's Curatorial Opportunity Program, accepting proposals for 6-week exhibitions from September 2019 to May 2020.
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Liability Waiver Form
PDF template
A legal document releasing the University of Louisville from liability for participation in the Suzuki Studies Program and acknowledging program policies.
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City Of Socorro 2024 Cornhole League Registration
PDF template
Registration form for participating in the City of Socorro's 2024 Cornhole League, including league rules and liability waiver.
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COVID 19 Incident Report Form
PDF template
A form to document and track potential COVID-19 exposure and incidents among employees.
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Corps Of Cadets Preparticipation Physical Evaluation Medical History
PDF template
Medical history and health evaluation form required for admission to the Texas A&M Corps of Cadets, verifying medical fitness for cadet program participation.
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Corrected (Replacement)Voided Claim Request Form
PDF template
A form used to correct or void previously processed healthcare claims with specific submission requirements.
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RPCI.GEN.LAB.PATH.Frm.0023.00 Delivery Form
PDF template
A form for tracking and delivering medical laboratory samples between locations.
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Course Placement Waiver Form
PDF template
A form allowing students and parents to request course placement that differs from school recommendations, acknowledging potential academic risks.
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PETITION FOR COURSE SUBSTITUTION OR WAIVER FORM
PDF template
A form for students to request course substitutions or waivers in their academic degree requirements.
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Course Waiver Form
PDF template
A form for students to request a waiver of a required course in their academic program through departmental recommendation.
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Course Waiver Request
PDF template
A form for students to request a waiver from specific course requirements, requiring multiple approvals from academic officials.
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Course Waiver Form
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A form for students to request waiving a course requirement based on previous course completion at another institution.
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Course Waiver Form
PDF template
A form for students to request a waiver for a required course in their academic degree program.
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Waiver Form
PDF template
A comprehensive waiver form for participation in camp activities, requiring participant information and acknowledging potential risks.
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Waiver Form
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A comprehensive waiver document for participants at Covenant Harbor Bible Camp and Retreat Center, covering liability and participation risks.
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NEW YORK STATE TRAVELER HEALTH FORM
PDF template
A required form for individuals entering New York from non-contiguous states, territories, or countries, capturing traveler health and contact information.
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Emergency Leave Request Form
PDF template
A form for employees to request emergency leave related to COVID-19 circumstances and workplace absences.
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COVID 19 Employee Report Form
PDF template
A form for employees to report COVID-19 positive tests or symptoms, used by Wichita State University for tracking and workplace safety purposes.
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Paid COVID 19 Leave Request Form
PDF template
A form for Minnesota executive branch employees to request paid leave related to COVID-19 circumstances under Executive Order 20-07.
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COVID 19 Leave Request Form
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Form for Kansas Department of Transportation employees to request leave related to COVID-19 exposure or symptoms
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COVID 19 Case Interview Form
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A detailed medical form used by the Florida Department of Health to collect information about COVID-19 cases and patient symptoms.
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Employee COVID 19 Leave Request Form
PDF template
Form for employees to request leave related to COVID-19 circumstances, including medical diagnosis, quarantine, or childcare needs.
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COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave related to COVID-19 situations, including quarantine, illness, and childcare needs.
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COVID 19 Leave Request Form
PDF template
Form for employees to request leave related to COVID-19 circumstances, including quarantine, household exposure, and vulnerable health status.
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COVID 19 Testing And Symptom Assessment For New Enrolled Student(S) From Out Of CountryState AndOr C
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A health screening form for students to assess COVID-19 symptoms and testing status before school enrollment or return from travel.
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COVID 19 DISABILITY FORM
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A comprehensive medical information form designed to help healthcare providers understand and support patients with disabilities during COVID-19 related medical treatment.
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Medical Information Request Form For COVID 19 Temporary Reasonable Accommodation For Faculty, Admini
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Form for Fordham University employees to request workplace accommodations related to COVID-19 high-risk medical conditions
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COVID 19 OTC Test Reimbursement Form
PDF template
Form for submitting reimbursement claims for personally purchased FDA-approved COVID-19 over-the-counter tests.
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REQUEST FOR COVID 19 LEAVE
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A form for Miami-Dade County employees to request paid sick leave related to COVID-19 reasons and circumstances.
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COVID 19 Participant Code Of Conduct And Risk Assessment Form
PDF template
Comprehensive safety guidelines and risk acknowledgment for Special Olympics participants during the COVID-19 pandemic.
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COVID 19 PERSONAL HEALTH RISK ASSESSMENT FORM
PDF template
A comprehensive form to assess individual health risks and COVID-19 exposure for meeting participation and travel to Italy.
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DOH COVID 19 Vaccination Consent Form
PDF template
A comprehensive form for collecting patient information and screening for COVID-19 vaccination eligibility.
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Risk Assessment Form For COVID 19 Contact
PDF template
A form for documenting potential COVID-19 exposure and health status for university students and staff.
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COVID 19 SPECIMEN SUBMISSION FORM
PDF template
Form for submitting COVID-19 test specimens to the Massachusetts State Public Health Laboratory for PCR testing.
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COVID 19 TESTING PATIENT INTAKE FORM
PDF template
Demographic and medical intake form for COVID-19 testing in compliance with CARES Act reporting requirements.
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Communicable Disease Related Hold Harmless, Release, Waiver Of Liability, And Indemnity Agreement
PDF template
Legal document releasing event organizers from liability related to potential communicable disease exposure during an event.
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COVID 19 Order Form
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Medical form for collecting patient information and COVID-19 specimen details for testing purposes.
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COVID 19 Release Of Liability Form
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Release of liability form for Pacific Crest Trail Association volunteers during COVID-19 pandemic, outlining risks and participant responsibilities.
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COVID 19 SUPPLEMENTAL PAID SICK LEAVE REQUEST FORM
PDF template
A form for employees to request supplemental paid sick leave related to COVID-19 vaccination, quarantine, or family care needs.
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Vaccine Recipient Information And Consent Form
PDF template
A medical consent form for receiving COVID-19 vaccines, capturing patient information and legal authorization for vaccination services.
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COVID 19 Vaccine Consent And Waiver Form
PDF template
A legal consent form for receiving the COVID-19 vaccine, detailing risks, acknowledgements, and patient agreements.
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PARENTALGUARDIAN, SCOUT, LEADER COVID 19 ACKNOWLEDGEMENT CONSENT WAIVER FORM
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A waiver form acknowledging COVID-19 risks for scout activities and granting permission for participation during the pandemic.
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NEW PATIENT INTAKE FORM
PDF template
Comprehensive medical intake form for new patients at a women's wellness practice, collecting personal and medical information.
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Medical Form For Volunteers
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A comprehensive medical screening form for volunteers to assess health status and eligibility for participation in Camp Promise/Jett Foundation programs.
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Medical Form For Campers
PDF template
A comprehensive medical form for documenting a camper's health status, medical history, and physical examination details for participation in Camp Promise/Jett Foundation programs.
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CPJ Emergencies Risk Assessment Template
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A comprehensive risk assessment template for journalists to evaluate potential safety risks and develop mitigation strategies for reporting assignments.
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The UPS Store Shipping Form
PDF template
Shipping instructions and form for artists submitting paintings to the 2018 Renaissance in Pastel exhibition at UConn Stamford Art Gallery.
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Center For Pediatric Therapies Volunteer Application Form
PDF template
A comprehensive application form for potential volunteers at the Center for Pediatric Therapies, including medical and contact information.
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CRAFFTN Interview Form
PDF template
A confidential medical screening form for assessing substance use and potential risks among adolescents or young adults.
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Physical Examination Form
PDF template
Comprehensive medical examination form for assessing physical fitness, likely for occupational certification purposes.
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Creative Earth A COP26 Art Competition Entry Form
PDF template
A competition entry form for young artists to submit artwork related to the future of the planet, organized in connection with COP26.
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Patient Medical Intake Form
PDF template
Medical intake and financial responsibility form for orthopedic patient evaluation, specifically for injury-related medical treatment.
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Credit Card Pre Authorization Form
PDF template
A form authorizing Creekside Counseling + Wellness to charge client's credit card for services, copayments, and fees.
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Credit Card Pre Authorization Form
PDF template
Form authorizing Valleycare Gastroenterology Medical Group to charge credit card for patient balances and medical services
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CreditRefund Request Form
PDF template
A form for participants to request credit or refund for YMCA programs with specific policy guidelines.
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Clinical Research Education Training Program (CRETP) Application Student Evaluation Form
PDF template
A form used to evaluate student characteristics and potential for participation in a clinical research training program.
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Criminal Background Check Waiver Release Form
PDF template
A form for housing applicants to authorize a criminal background check and provide necessary documentation for Texas State Technical College housing application.
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Criminal Background Check Waiver Release Form
PDF template
A form for housing applicants to authorize a criminal background check and release liability for Texas State Technical College.
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Crisis Leave Request Form
PDF template
A form allowing employees to request leave from a Crisis Leave Pool for personal or family health conditions or extraordinary personal crises.
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PhysicianS Mammography Evaluation Form
PDF template
Detailed assessment form for evaluating mammography image quality and technical standards.
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Critical Facility Assessment Form
PDF template
A comprehensive emergency response assessment form for facilities in Chicago to provide critical information for first responders.
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DMMA Critical Incident Form
PDF template
A comprehensive form for documenting and reporting critical incidents involving healthcare members or patients.
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Advance Conflict Waiver Form Language
PDF template
A document outlining potential conflict of interest scenarios in legal representation for financial transactions.
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Informed Consent Self Assessment Form
PDF template
An electronically fillable PDF version of the Informed Consent Self-Assessment tool to help study teams evaluate their informed consent process.
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CLINICAL GENETICS PROGRAM REFERRAL FORM (GENERALPRENATAL)
PDF template
A medical referral form for genetic consultation and testing services, used by healthcare providers to submit patient referrals for genetic assessment.
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Hepatitis C Virus (HCV) Treatment Procedure
PDF template
Montana Department of Corrections clinical procedure for monitoring and treating Hepatitis C Virus among offenders in secure care facilities.
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Committee For Specialist International Medical Graduate Education (CSIMGE) Area Of Need Ongoing Asse
PDF template
Comprehensive evaluation form for assessing international medical graduates' clinical performance, professional skills, and competencies in a medical setting.
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Employer Support Declaration Form
PDF template
A form documenting employer support for an international medical graduate's pathway to fellowship with the Royal Australian and New Zealand College of Psychiatrists (RANZCP)
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Required Consent For Release Of Information
PDF template
A consent form for releasing a child's medical, mental health, and treatment information for intensive mental health services coordination in New York City.
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CSS Profile Waiver Request For The Noncustodial Parent
PDF template
A form allowing students to request a waiver for noncustodial parent financial information when applying for financial aid.
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Profile Waiver Request For The Noncustodial Parent
PDF template
A form for students to request a waiver of the CSS Profile requirement for a noncustodial parent in specific circumstances such as abuse or no contact.
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CSS Profile Waiver Request For The Noncustodial Parent
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A form for students seeking to waive the requirement of obtaining CSS Profile information from a noncustodial parent in financial aid applications.
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Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement
PDF template
Legal document waiving liability for participation in University of California community service transportation program.
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EMS Contact Form
PDF template
Form for EMS departments to request keying their MedVault emergency override key the same as their KnoxBox Rapid Access Program Master Key.
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Colorado State University Pueblo Event ParticipationMedical Form
PDF template
Comprehensive medical form for capturing participant health information, emergency contacts, and medical history for Colorado State University Pueblo events.
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Circulating Tumor Cell Core Laboratory Requisition Form
PDF template
A requisition form for submitting samples to the Circulating Tumor Cell Core Laboratory for enumeration and profile analysis.
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CTE Hospital Occupations Internship Class Application Form
PDF template
Application for high school students to participate in a medical internship program at UCI Medical Center, involving job shadowing and clinical skills training.
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CT, MRI And MRA Order Pre Authorization Form
PDF template
A comprehensive form for ordering CT, MRI, and MRA medical imaging exams with detailed patient and clinical information requirements.
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CPT Codes List
PDF template
Comprehensive list of Current Procedural Terminology (CPT) codes for various CT and diagnostic imaging procedures.
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Nebraska Career Student Organization Medical Release Form
PDF template
A medical consent and emergency contact form for student organization members, allowing medical treatment authorization in parent/guardian's absence.
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Cub Scout Activity Waiver Form
PDF template
A waiver form for youth and adult participation in Cub Scout activities, addressing medical and safety requirements.
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Cultural Product District Program Guidelines
PDF template
Provides tax exemptions for original art sales and tax credits for historic property rehabilitation within designated cultural districts in Louisiana.
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Attending Physician Statement
PDF template
Medical documentation form used to assess patient's medical condition and ability to work for disability evaluation purposes.
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CUNY Off Campus Activity Participation, Waiver, And Emergency Contact Form (Domestic Travel)
PDF template
A form for students to acknowledge risks and provide emergency contact information for off-campus activities at CUNY.
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CUNY Release Agreement For Activities In A Destination Under A Travel Warning
PDF template
A legal document outlining risk assumptions and compliance requirements for CUNY travelers going to destinations with travel warnings or advisories.
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SHORT TERM DISABILITY CLAIM FORM
PDF template
Form for employees to file a claim for short-term disability benefits, including personal and employment details.
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Direct Deposit Authorization
PDF template
A form for setting up or changing direct deposit banking information for reimbursement payments.
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Payment Request Form
PDF template
A form for requesting payment for self-directed services within a Medicaid waiver program, requiring detailed vendor and service information.
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University Undergraduate Curriculum Committee Curricular Proposal Form Guide
PDF template
A comprehensive guide and form for proposing curricular changes, new programs, and course modifications at the university level.
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Scholarship ApplicationRegistration Form
PDF template
A form for students to apply for art class scholarships based on financial need and family income.
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Participant Consumption Of Alcohol Information And Waiver Form
PDF template
A form outlining alcohol consumption guidelines and restrictions for adult participants in Champaign-Urbana Special Recreation activities.
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CUHSR Approved Informed Consent Form Language For Research Studies Using Participant Incentives
PDF template
Guidelines for documenting participant compensation and tax implications in research studies at Bradley University
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Short Tissue Repository Research Consent Form
PDF template
Consent form for patients to participate in a genetic research biorepository studying cardiovascular health and disease factors.
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REFERRAL FORM B Specialist
PDF template
A medical referral form used by Citrus Valley Physicians Group to request specialist services and track patient referrals.
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Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, including patient and pharmacy information, insurance details, and claim reasons.
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Accident Waiver, Release Of Liability Informed Consent Form
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Legal document waiving liability for participants in activities at the Colonial Williamsburg Musket Range.
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Accident Waiver, Release Of Liability Informed Consent Form
PDF template
Legal document waiving liability for participants in activities at the Colonial Williamsburg Musket Range.
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Patient Registration Form
PDF template
A comprehensive medical intake form for collecting patient personal and insurance details for healthcare services.
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CAREER EXPLORATIONS 2024 REGISTRATION AND EMERGENCYMEDICAL RELEASE FORM
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Registration form for high school students to participate in a two-day career exploration program at Johnson & Wales University campus.
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Application For Appointment In Cytopathology Fellowship Program
PDF template
Application form for medical professionals seeking a fellowship in cytopathology at the University of Massachusetts Medical School/UMass Memorial Health Care.
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Pathology Requisition Cytology
PDF template
Medical form for collecting patient cytology test information, clinical history, and diagnostic details for gynecological testing.
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Consent For The Medical Treatment Of A Minor
PDF template
A consent form authorizing medical treatment for a minor student at Sam Houston State University Health Center with payment responsibility details.
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Request For Records Disposition Authority
PDF template
Official document detailing records disposition for Commissioned Corps Officers in the U.S. Department of Health and Human Services.
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Medical Form Requirements
PDF template
Comprehensive guide for medical form requirements for Boy Scouts of America camps and activities in Colorado.
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Daily Safety Inspection Form
PDF template
A comprehensive form for documenting employee personal protective equipment (PPE) and safety gear compliance during workplace inspections.
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DAMAGE ASSESSMENT FORM
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A form used by Community Emergency Response Team (CERT) members to document damage and conditions during emergency response assessments.
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MEDICAL INQUIRY FORM IN RESPONSE TO AN ACCOMMODATION REQUEST
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A medical form used to assess an employee's disability status and potential need for workplace accommodations under the Americans with Disabilities Act (ADA).
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PARKING ACCOMMODATION STATEMENT OF MEDICAL NECESSITY
PDF template
Medical certification form for employees requesting parking accommodations due to disability or medical limitations
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New Provider Data Form
PDF template
Comprehensive registration form for medical providers to submit personal and professional information for onboarding with CHS Medical Group.
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New Provider Data Form
PDF template
Comprehensive form for medical providers to submit personal and professional information for registration with CHS Medical Group.
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DocuSign Analyzer Datasheet
PDF template
An AI-driven tool that helps organizations analyze, negotiate, and review incoming agreements more efficiently by extracting key terms and generating risk scorecards.
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Bartlett Park District Registration Form
PDF template
Registration form for park district programs with participant information, payment details, and liability waiver.
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Davenport Emergency Grant Application Form
PDF template
Application for emergency financial assistance for veterans through the Broomfield Veterans Memorial Museum Davenport Fund
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SSM Health Davis Duehr Dean Eye Care Referral Form
PDF template
Medical referral form for patients needing eye care services at SSM Davis Duehr Dean Eye Care clinic, used to transmit patient and clinical information.
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Interpreter Evaluation Form
PDF template
A comprehensive form to evaluate the performance and skills of medical interpreters across multiple dimensions of communication and professionalism.
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Evacuation Planning Form For Child Care EmergencyDisaster Preparedness
PDF template
A comprehensive form for child care providers to develop and document emergency evacuation procedures and disaster preparedness strategies.
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Emergency Consent Form
PDF template
A medical consent form that allows parents or guardians to provide advance authorization for emergency medical treatment of a child.
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RETIRED LAW ENFORCEMENT OFFICER IDENTIFICATION CARD
PDF template
Liability waiver for retired law enforcement officers seeking to carry a concealed firearm under LEOSA provisions.
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Emergency Medical Release
PDF template
A comprehensive medical release form for participants, collecting emergency contact, health, and treatment authorization information for minors.
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Adult Patient Intake Form
PDF template
A comprehensive form for collecting patient medical history, personal information, and health details for treatment planning.
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DCTD Tumor Repository International Shipping Form
PDF template
A form for shipping tumor repository samples internationally, used by researchers to request and document biological material shipments.
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Uniform Consultation Referral Form
PDF template
A comprehensive form for healthcare providers to refer patients to consultants, detailing patient, provider, and referral information.
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DD FORM 2789
PDF template
A Department of Defense form for requesting waiver or remission of financial indebtedness for military and civilian personnel.
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DD Form 2807 2 Medical Prescreen Of Medical History Report
PDF template
A form used by military recruiters to pre-screen medical history of potential military service applicants for the United States Armed Forces or Coast Guard.
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DD FORM 2876 3, TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM
PDF template
Official Department of Defense form for enrolling, disenrolling, or changing primary care managers in the TRICARE Prime healthcare program.
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DD FORM 2876 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM
PDF template
A Department of Defense form for enrolling, disenrolling, or changing primary care managers in the TRICARE Prime healthcare program.
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Waiver Of Notice Of Proposed Action
PDF template
Legal form allowing waiver of notice rights for actions in estate administration by a personal representative.
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DEA Order Form 222
PDF template
Official form for ordering Schedule I and II controlled substances from authorized suppliers, requiring detailed tracking and record-keeping.
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DECA ICDC 2023 Registration Guide
PDF template
Official registration and permission form for DECA conference attendance, including medical authorization and conduct agreement.
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Diver Medical Questionnaire Additional Declarations COVID 19
PDF template
A medical questionnaire and health declaration form for divers to assess fitness and COVID-19 risk prior to participating in diving activities.
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Decode Duchenne Test Requisition Form
PDF template
A comprehensive genetic testing requisition form for patients with suspected or confirmed Duchenne or Becker muscular dystrophy
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License Agreement For Diabetes Empowerment Education Program
PDF template
A licensing agreement between the University of Illinois and a licensee for the use and distribution of the Diabetes Empowerment Education Program
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Participant Agreement, Release And Assumption Of Risk
PDF template
Legal waiver and risk assumption document for participants in trampoline and interactive activities, specifically for participants under 19 years old.
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BIRTH TO TWENTY DELIVERY FORM
PDF template
Comprehensive medical form documenting pregnancy and childbirth details for medical research and tracking.
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Dental Claim Form
PDF template
A standardized form for submitting dental insurance claims, tracking patient treatment, and requesting predetermination or preauthorization.
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Delta Dental Of Minnesota Membership Enrollment Form
PDF template
Membership enrollment form for Delta Dental insurance coverage, allowing employees to select dental plan options and enroll dependents.
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Patient Intake Form
PDF template
Comprehensive patient registration form collecting personal, contact, and insurance information for medical practice.
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Demographics And Insurance Form Surgery Registration
PDF template
Comprehensive patient intake form for surgical procedures, collecting patient demographics, insurance, and medical contact information.
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Oral Health Assessment Form
PDF template
California-mandated form for documenting children's dental health screenings required before first year of public school.
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DENTAL CONE BEAM CT REFERRAL FORM
PDF template
A medical referral form for dental cone beam CT imaging studies with patient and physician information collection.
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Dental Insurance EnrollmentWaiver Form
PDF template
A comprehensive form for employees to enroll or waive dental insurance coverage, including personal and dependent information.
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Proof Of School Dental Examination Form
PDF template
State of Illinois form documenting mandatory dental examination for school children in specific grade levels.
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Proof Of School Dental Examination Form
PDF template
A mandatory dental health examination form for students in specific school grades in Illinois, documenting their oral health status.
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Proof Of School Dental Examination Form
PDF template
Official form documenting student dental health examination for Illinois school children in specific grade levels as required by state law.
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Proof Of School Dental Examination Form
PDF template
Official document requiring dental examination for students in specific school grades, documenting oral health status and screenings.
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Kentucky Dental ScreeningExamination Form For School Entry
PDF template
Official form for documenting dental screening or examination required for school entry in Kentucky for five or six-year-old students.
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Proof Of School Dental Examination Form
PDF template
Official form for documenting a student's dental health examination required for school enrollment in Illinois.
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Dental Examination Waiver Form
PDF template
A form for parents or guardians to request a waiver for required dental examinations for students in Illinois schools.
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Dental Examination Waiver Form
PDF template
A form for parents/guardians to request a waiver from required dental examination for school-enrolled children in Illinois.
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Dental Examination Waiver Form
PDF template
A form allowing parents/guardians to request a waiver for required dental examinations for students due to specific insurance or access constraints.
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Proof Of School Dental Examination Form
PDF template
Official state form documenting dental health examination for school-aged children in Illinois, mandated by state law for specific grade levels.
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PROOF OF DENTAL EXAM
PDF template
An official dental examination form for students, documenting oral health status and treatment needs.
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WCTC Dental Hygiene Clinic MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form for patients at a dental hygiene clinic, collecting personal information and medical conditions.
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Dental Hygiene Consent Form
PDF template
A comprehensive consent form outlining patient expectations, treatment policies, and administrative guidelines for dental services.
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Dental Waiver Form
PDF template
A form allowing civil service staff to waive enrollment in Genesee Community College's group dental insurance plan.
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PATIENT MEDICAL HISTORY FORM
PDF template
A comprehensive medical and dental history form for patient intake, collecting personal health information and current medical status.
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Dental Medical Release Form Template
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A template form for patients to authorize medical information release and consent for dental treatment.
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Kentucky Dental ScreeningExamination Form For School Entry
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A mandatory dental health screening form for children entering public school in Kentucky, documenting dental health status and examination details.
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DentalVision Enrollment Form
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Detailed guide for completing a dental and vision insurance enrollment form with step-by-step instructions.
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Patient Referral Form
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A comprehensive medical and dental referral form for patient intake and specialist consultation at Boston Children's Hospital dental services.
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Medical History Form
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Comprehensive medical history form collecting personal health information, medical background, and current health status.
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Climate Health WA Inquiry
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Submission by Department of Local Government, Sport and Cultural Industries addressing climate change health impacts in Western Australia
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Dependent Audit Form
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A form for employees to verify and update dependent insurance coverage information and personal details.
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DepartmentProgram Transfer Request Form
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Form for students requesting transfer between departments or programs within the Rollins School of Public Health.
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Dermatology Medical History
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Comprehensive medical history form for dermatology patients to document health conditions, medications, and allergies.
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DERMATOLOGY MEDICAL HISTORY FORM
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Comprehensive medical history form for dermatology patients to document existing health conditions, medications, and potential skin-related medical concerns.
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Dermatopathology Requisition Form
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Medical form for submitting wet or fresh tissue specimens for dermatopathology analysis and diagnostic testing.
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Designee Registration Form
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A registration form for third-party entities interacting with Illinois Shines program end-use customers, establishing transparency and program participation requirements.
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DESIGN FRINGE REGISTRATION INFO PACK
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Registration information for a design exhibition showcasing works by Australian-based artists and designers at all career stages.
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Commercial Business Emergency Contact Information
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Confidential form for local police department to collect emergency contact details for commercial businesses
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Des Plaines Park District Waiver Form
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Waiver and release form for sports team participants to acknowledge and accept potential risks associated with participation.
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DFS 405 Onsite Sewage Agency Referral Form
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Official form documenting the evaluation of a property's suitability for onsite sewage disposal systems in Kentucky.
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Shipping Assessment Form
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A comprehensive form for assessing and documenting shipments of various materials to and from Weill Cornell Medicine, requiring detailed information about shipping contents and requirements.
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CONSENT FORM CONFIDENTIAL HUMAN IMMUNODEFICIENCY VIRUS (HIV) TEST Non Health Care Settings
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Official consent form for HIV testing in non-healthcare settings, documenting informed consent and explaining testing procedures.
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REFERRAL FOR CONSULT OR PROCEDURE
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Medical referral form for patients seeking consultation or procedures at Stanford Health Care's Digestive Health and Liver Clinic
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Patient Medical History Form
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Comprehensive medical history form for collecting patient personal information, contact details, and health status.
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Type 2 Diabetes Risk Assessment Form
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A screening tool to evaluate an individual's risk factors for developing type 2 diabetes through a points-based assessment.
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Request For Diagnostic Imaging
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Medical form for requesting and scheduling diagnostic imaging procedures such as X-Ray, Ultrasound, CT, and Nuclear Medicine.
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NWU2014 04 01 Participant Contact Form Data Dictionary
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A data dictionary for documenting participant contact form variables and metadata for a research study.
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MDA2016 08 02 Study Specimen Shipping Form Blood Data Dictionary
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A data dictionary detailing the variables and specifications for a blood specimen shipping form used in a medical study.
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MDA2014 04 01 Specimen Shipping Form Tissue Data Dictionary
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A comprehensive data dictionary for tracking and recording specimen shipping information for tissue samples across multiple medical institutions.
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Student Record Card 6
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A health record and immunization documentation form required for student enrollment in Montgomery County Public Schools in Maryland.
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Stanford Health Care Referral For Consult Or Procedure
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A medical referral document for patients seeking consultation or procedures at Stanford Digestive Health and Liver Clinic.
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DIGITAL SLIDE ORDER REQUEST FORM
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A form for requesting digital slide scanning services at UCLA with options for magnification, scanner type, and image delivery method.
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DIRECT ACCESS PATIENT ATTESTATION AND MEDICAL RELEASE FORM
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A form for patients seeking physical therapy care, documenting current medical care status and providing medical record release consent.
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Directed Quarantine Leave Request Form
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Form for Philadelphia School District employees to request paid quarantine leave due to COVID-19 exposure or positive test result.
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Athlete Registration Form, Athlete Release Form Athlete Medical Forms
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Detailed guide for completing and submitting athlete registration and medical documentation for participation.
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Molina Healthcare Of California Direct Referral To Specialist
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A referral form for Molina Healthcare members to receive specialized medical services within their network of contracted specialists.
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VCHCP PCP DIRECT REFERRAL FORM
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A medical referral form for primary care physicians to refer patients to contracted specialists within the Ventura County Health Care Plan network.
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DIS 101C V7 EMPLOYEE STATEMENT DISABILITY CLAIM FORM
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A comprehensive form for employees to file a disability claim for short-term or long-term disability benefits.
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SUPPLEMENTAL DISABILITY CLAIM FORM
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Claim form for submitting a disability benefit request for IUOE Local 132 Health and Welfare Fund participants
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Group Disability Claim Filing Instructions
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Instructions for filing a disability insurance claim with American Fidelity Assurance Company, detailing the required steps and documentation.
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DISABILITY HEALTH WELFARE HOURS CLAIM FORM
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A form for participants to claim disability hours and benefits through the Southwest Carpenters Health & Welfare Trust
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Disability Health Welfare Hours Claim Form
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A form for carpenters to claim disability health and welfare hours due to illness or injury, requiring participant and physician statements.
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Disability Claim Form
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A comprehensive form for submitting a disability insurance claim, detailing the policyholder's medical condition and disability status.
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Delta Pilots Mutual Aid Disability Claim Form
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Disability claim form for Delta pilots to request benefits and authorize medical information release and payment processing.
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Short Term Disability Claim Form
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A comprehensive form for employees to file a claim for short-term disability benefits, requiring input from the employee, employer, and attending physician.
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Disability Claim Form Instructions
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Comprehensive instructions for filing a disability insurance claim with sections for physician, claimant, and employer statements.
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Disability Claim Form
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A comprehensive disability claim form for union members to document medical conditions, work status, and employer information.
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Disability Claim Form
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A comprehensive form for filing a disability claim with medical and employment details for Teamsters Joint Council No. 83 members.
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Disability Claim Form
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A comprehensive form for filing a disability claim through the Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds.
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Continuing Disability Claim Form
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A comprehensive form for filing a disability insurance claim covering various types of disability and patient information
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N 648 Medical Certification For Disability Exceptions
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Guidelines for medical professionals assessing disability exceptions for refugees seeking U.S. citizenship, focusing on comprehensive and culturally sensitive evaluation methods.
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Short Term Disability Reporting Form
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A reporting form for employees to document short-term disability leave and absence from work due to illness or non-work related injury.
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Supplementary Disability Claim Form
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A form used to submit disability claims, requiring details from both the claimant and attending physician about an employee's inability to work.
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SI 11268 Your Disability Benefit Claim
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Application packet for submitting a long-term disability benefits claim, including instructions for completing required forms.
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Certification For Tuition Waiver Form
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A form for students with permanent disabilities to request a tuition waiver based on social security disability benefits.
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Adapted Physical Education Program Medical Form
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Medical form documenting student's disability, exercise limitations, and physical capabilities for adapted physical education program participation.
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Guide For Tuition Waiver For Students With Disabilities
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A guide explaining tuition waiver eligibility for Maryland residents with permanent disabilities who wish to enroll in community college courses.
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Disaster Financial Assistance
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A government form providing financial assistance for residential property damage from a specific disaster event in Nova Scotia.
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How To File A Claim For Weekly Disability Benefits
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Comprehensive guide for filing a disability benefits claim, including required documentation and medical certification requirements.
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Discharge Form
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A form used to document patient discharge from a healthcare facility with multiple completion options.
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Discharge And Follow Up Recommendations
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Guidelines for healthcare personnel on discharge and follow-up care for patients who have experienced assault, including medical and mental health considerations.
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DISCHARGE PLANNING INPATIENT STANDARDS
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A comprehensive protocol detailing the procedures and responsibilities for patient discharge from an inpatient healthcare facility.
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Pediatric Discharge Summary Template
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A comprehensive template and instructions for creating a pediatric patient discharge summary with detailed guidelines for documentation.
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Discussion Period Request Form
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Form for healthcare providers to request a review of a claim determination and provide additional supporting documentation within a 30-day period.
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International Medical History Form
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Comprehensive medical form for collecting personal health information, emergency contacts, and medical history for international travel purposes.
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International Medical History Form
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Comprehensive medical history and emergency contact form for international travelers to ensure safety and medical preparedness.
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MLML AAUS Diving Medical Form
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Medical examination form for assessing fitness of scientific divers, detailing potential disqualifying medical conditions for diving certification.
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DIVING MEDICAL HISTORY FORM
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A comprehensive medical history form designed to assess an individual's fitness and health risks for participating in scuba diving activities.
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UM Diver Proof Of Insurance Form
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Form requiring proof of medical insurance coverage for potential scuba diving accidents and hyperbaric oxygen therapy
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UM Diver Proof Of Insurance Form
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A form requiring divers to prove they have medical insurance coverage for potential scuba diving accidents involving hyperbaric oxygen therapy.
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Diversity Drives Us Art Competition Entry Form
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Application form for artists to submit artwork for the PSTA Diversity Art Competition, exploring themes of diversity and inclusion.
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APPENDIX 15 DIVING INCIDENT REPORT FORM
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A comprehensive form for reporting diving-related accidents, injuries, and incidents with detailed documentation requirements.
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DIZZINESS BALANCE MEDICAL HISTORY QUESTIONNAIRE
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Comprehensive medical questionnaire for patients experiencing dizziness, balance issues, and related symptoms
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College Credit Waiver Application
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Application for law enforcement officers to request waiver of college credit requirements in Wisconsin.
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NC Medicaid Hospice Prior Approval Authorization Form
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A form for healthcare providers to request prior authorization for Medicaid hospice benefits for patients entering a new benefit period.
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CCNCCA Enrollment Form
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Enrollment form for healthcare program participation, allowing individuals to enroll multiple people and select primary care providers.
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Individual Volunteer Registration AgreementTime Record
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Agreement for volunteers to register and track service time with the Department of Natural Resources, including liability waiver and image consent.
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Referral
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A comprehensive medical referral document for tracking patient information and transfer of care between healthcare providers.
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DoctorS Signature Form
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A comprehensive medical form for documenting a camper's health information, medical history, medications, and physician details.
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Organizational Hold Harmless And Indemnity Agreement
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Legal document that provides liability protection for Boy Scouts of America against claims from non-BSA scouting groups and organizations.
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Minor (Under 18) Participant Form
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Registration and liability waiver form for minors participating in sports activities at Accelerate Sports complex.
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Document Waiver Form
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A form for applicants to request waiver of required submittal documents when applying for building permits online.
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The 1st Annual Ridgecrest Regional Hospital Dodgeball Tournament 2017 Waiver Form
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Legal waiver for participants in the Ridgecrest Regional Hospital Dodgeball Tournament, releasing the hospital from liability for potential injuries.
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Authorization For The Release Of Health Information And Confidential HIV Related Information DOH 255
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A form for releasing general health and HIV-related information to single or multiple healthcare providers with specific guidelines for usage.
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Authorization For Use Or Disclosure Of Protected Health Information (PHI)
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A legal form allowing authorized use and disclosure of an individual's protected health information by the Hawaii State Department of Health.
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DOH COVID 19 Vaccination Consent Form
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A comprehensive form for capturing patient information and screening for COVID-19 vaccination eligibility and potential health risks.
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COVID 19 Emergency Paid Leave (EPL) Employee Notification And Supplemental Leave Request Form
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Form for federal employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
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Build America, Buy America Act (BABAA) Domestic Sourcing Requirements Waiver Request Form
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A form for requesting a waiver from domestic sourcing requirements for Department of Education grant programs under the Build America, Buy America Act.
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INFORMED CONSENT TO DONATE EMBRYOSWAIVER OF LIABILITY
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Legal document for donating cryopreserved embryos to the National Embryo Donation Center for reproductive purposes.
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Do Not File Insurance Waiver Form
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A document allowing patients to request that Oklahoma State University Medicine not file an insurance claim for a specific date of service.
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EducationalAcademic Travel Pre Authorization Form For Out Of Province Travel
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A pre-approval form for faculty, clinical associates, and trainees to document and obtain approval for out-of-province travel related to educational or academic purposes.
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I 612, Application For Waiver Of The Foreign Residence Requirement
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Instructions for applying for a waiver of the two-year foreign residence requirement for certain exchange visitors seeking immigration or visa status.
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TESTING REQUISITION FORM
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Specialized medical form for flow cytometry testing of blood and bone marrow specimens for various hematological conditions.
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Driver Medical History Form
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Medical history and physical examination form for taxi and limousine drivers to assess fitness for operating a motor vehicle.
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Chapter 133. General Medical Provisions Subchapter B. Health Care Provider Billing Procedures
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Regulatory document specifying required electronic and paper billing formats for healthcare providers in workers' compensation and insurance contexts.
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Artist ApplicationAgreement
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A legal document for artist participation in Buttonwood Art Space activities, including a waiver of liability and hold harmless agreement.
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Medical Certification Form New Driver Applicant
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Medical certification document required for new taxi and livery vehicle drivers in New York City to verify physical fitness for driving.
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Integrative Medicine Intake Form
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Comprehensive medical intake form for patients seeking integrative medicine services, collecting medical history, current health concerns, and personal health information.
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Medical Drop Off Consent Form
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A consent form for veterinary medical services and pet drop-off, including pet health status and treatment authorization.
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Drug Testing Consent Form
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A comprehensive consent form for drug testing administered by the Manila Health Department Public Health Laboratory for various purposes.
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BP 5131.61 Student Athlete Drug Testing
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A school district policy establishing a drug testing program for student athletes to promote health, safety, and deterrence of substance abuse.
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Youth Membership Form (Under 18)
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A comprehensive membership form for youth under 18 to join senior and multigenerational center programs in Albuquerque.
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Medical Examination Form
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Comprehensive medical examination form documenting patient's physical condition, vision, hearing, and overall health status.
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Medical Examination For Immigrant Or Refugee Applicant (DS 2053)
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Comprehensive guide for panel physicians completing medical examinations for immigrant and refugee applicants, detailing required assessments and evaluation process.
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Student Insurance Claim Form
PDF template
A comprehensive insurance claim form for students to report medical examinations, illnesses, prescriptions, or injuries for insurance coverage.
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Direct Deposit Enrollment Authorization Form
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Authorization form for electronic benefit payments through direct deposit for Social Services programs in North Carolina.
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Registration Form
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Registration form for participants to sign up for park district programs with personal and payment information.
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Informed Consent For Fitness Assessment
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Consent document for participating in a comprehensive fitness assessment conducted by exercise physiology students at the College of St. Scholastica during the City of Duluth Health Fair.
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Informed Consent For Fitness Assessment
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Consent document for a fitness assessment conducted by exercise physiology students at the College of St. Scholastica during a City of Duluth Health Fair.
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DyAnsys Brief Proposal Form
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A comprehensive form for researchers seeking project support and equipment loan from DyAnsys, including project details and research objectives.
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2022 WEDGE RESIDENCY Application Form
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An application form for artists and practitioners seeking a research residency in Vancouver, focused on exploring specific topics or histories related to the city.
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Employee Academic Tuition Waiver Request Form
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A form for Cameron University employees to request tuition waivers for themselves or their dependents for academic courses.
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Barcelona Portal Industry Booking Form
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Booking form for sponsorship and exhibition options at the EACTS 34th Annual Meeting virtual event in October 2020.
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Assumption Of The Risk, Release Waiver Of Liability
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Liability waiver for participants in a research program, acknowledging risks and providing emergency consent.
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EASA PROGRAM DISCHARGE FORM
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A form used to document client discharge details from the EASA program, including reasons for discharge and transition information.
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Patient Medical History
PDF template
Comprehensive medical history form for capturing patient personal information, health status, medical history, and patient rights.
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INITIAL DISABILITY CLAIM FORM
PDF template
A comprehensive form for filing disability insurance claims covering various types of disability scenarios with patient and policyholder information.
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Hazard Report Form
PDF template
A standardized form for employees to report potential workplace safety hazards and risks.
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Sponsorship Exhibition Booking Form
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Booking form for sponsorship and exhibition opportunities at the European Breast Cancer Conference (EBCC)
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Example Travel Health Declaration Form
PDF template
A form for collecting traveler health information, specifically related to Ebola outbreak monitoring during international travel.
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Volunteer Field Trip Waiver Form
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A waiver form for volunteers participating in activities with the East Bay Regional Park District, covering liability, medical consent, and photo permissions.
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Emergency Contact Form
PDF template
A form for collecting participant emergency contact details for a group or organization.
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Delaware Technical Community College Emergency Contact Form
PDF template
A confidential form for employees to provide emergency contact information for use by authorized personnel in case of an emergency.
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ECU School Of Dental Medicine Referral Form
PDF template
A comprehensive referral form for dental patients requiring specialized medical or dental services at East Carolina University School of Dental Medicine.
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NCAAR Drug Testing Program, 1999 2000
PDF template
Comprehensive drug testing program for student-athletes to ensure fair competition and athlete health and safety.
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EDI Application Form
PDF template
Application form for healthcare providers to submit electronic Medicare claims and receive electronic remittances through the Electronic Data Interchange (EDI) system.
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DDE Enrollment Form
PDF template
Form for healthcare providers to enroll in Direct Data Entry system and request access credentials for Medicare claims processing.
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Montana Conduent EDI Provider Enrollment Form
PDF template
A form for healthcare providers to enroll in electronic data exchange and authorize billing agent/clearinghouse transactions in Montana.
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Educational Seminar Grant Evaluation Form
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A form for documenting and evaluating educational seminars funded by the Collie Health Foundation, including event details, costs, and educational impact.
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Employee Request For Accommodation
PDF template
A form for employees to request workplace accommodations related to disabilities or medical conditions.
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Medical Reserve Corps Volunteer Application
PDF template
Application form for volunteers interested in joining the Medical Reserve Corps for public health emergency support
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Traveler Health And Medical Information
PDF template
A comprehensive guide for group leaders to collect and manage travelers' medical information and health considerations during travel programs.
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Emergency Family Medical Leave Request Form
PDF template
Detailed guidance for employees on completing timesheets and tracking Emergency Family and Medical Leave (EFML) usage and compensation.
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EnhanceFitness Post Program Evaluation Form
PDF template
A survey assessing participant experience and physical activity levels in the EnhanceFitness program.
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Extended Health Care Claim Form
PDF template
A comprehensive form for submitting medical and health care expense claims to an insurance provider, requiring detailed personal and coverage information.
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PeriodontalImplant Referral Form
PDF template
Medical referral form for periodontal and dental implant services with patient and examination details.
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Emergency Eye Wash Monthly Inspection Form
PDF template
Guidelines for monthly inspection and maintenance of emergency eye wash stations in laboratory settings to ensure safety and proper functionality.
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LABORATORY SAFETY INSPECTION WORK FORM
PDF template
A comprehensive checklist for evaluating safety protocols and environmental conditions in laboratory settings
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STUDENT MEDICAL HISTORY
PDF template
Comprehensive medical history form for students, covering various health aspects and potential medical conditions.
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Service Request Form
PDF template
A form for requesting environmental, health, and safety services from Environmental, Health & Safety Solutions, Inc.
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USEF Competition EHV 1 Declaration Form
PDF template
A health declaration form for horse owners and trainers to certify their horses' health status and exposure risk for EHV-1 at competitive events.
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2021 2022 Elementary School Request Form
PDF template
A form for schools to request Junior Achievement educational programs for elementary grade levels
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ELFR Presentation Request Form
PDF template
A form for requesting educational safety presentations by an emergency response team covering various safety topics for schools and organizations.
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Early Learning Scholarships Invoice Form SFY2024
PDF template
Invoice form for early childhood education programs serving Early Learning Scholarships Pathway I award recipient children to submit payment for eligible service expenses.
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Emergency Contact Changes
PDF template
A form for updating emergency contact information for a child's care center, including parental and emergency contact details.
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EMERGENCY CARE AND CONTACT FORM
PDF template
A school form for collecting student medical information, emergency contacts, and parental authorization for medical care.
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Emergency Contact Health Form
PDF template
Health and emergency contact form for participants in Lake County Forest Preserve programs, including medical information and treatment authorization.
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Emergency Contact Form
PDF template
Form for collecting emergency contact details and medical information for children participating in a program.
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Emergency Contact Form
PDF template
A form for collecting personal health details and emergency contact information for club or organizational trips.
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Emergency Contact Parental Consent Form
PDF template
A comprehensive form for collecting emergency contact, medical, and consent information for children in care.
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Emergency Contact Parental Consent Form
PDF template
A comprehensive form for collecting emergency contact, medical, and consent information for children in care facilities.
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Emergency Contact Form
PDF template
Form for collecting emergency contact information for Town of Salisbury employees in case of workplace emergencies.
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Emergency Contact Form
PDF template
A form for employees to list up to four emergency contacts to be used in case of emergencies during work hours or in town buildings.
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Emergency Contact Form
PDF template
A form for collecting emergency contact and medical information for volunteers participating in disaster response activities.
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MONROE COLLEGE MISSING STUDENT EMERGENCY CONTACT FORM
PDF template
A form for students to provide emergency contact information in case of an unexpected situation involving a missing student.
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St. Joseph School Emergency Contact Information
PDF template
Form for collecting student emergency contact details, health information, and parental consent for medical care
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Emergency Contact Information
PDF template
A form for collecting personal and emergency contact details for employees or students.
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Emergency Contact Form
PDF template
Form for businesses to provide emergency contact and security information to local police department
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Emergency Contact Form 32018
PDF template
A form for employees to provide contact information for emergency purposes and primary/secondary emergency contacts.
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Emergency Contact Form
PDF template
A comprehensive form for collecting student emergency contact details, medical information, and guardian contact information for school records.
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Emergency Contact Information Form
PDF template
A comprehensive form for collecting emergency contact details, business hours, and security information for a business location
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EMERGENCY CONTACT INFORMATION FORM
PDF template
A form for collecting comprehensive business contact and emergency information for local law enforcement records.
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Emergency Contact Form
PDF template
Form for students to provide emergency contact details for use in life-threatening situations or emergencies.
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Employee Emergency Contact Information
PDF template
A form for employees to provide emergency contact details for use in case of urgent situations.
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Student Emergency And Release Form
PDF template
Confidential form for collecting student medical information, emergency contacts, and special needs details for Howell Mountain Elementary School District.
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EMERGENCY CONTACT FORM
PDF template
A comprehensive form for collecting emergency contact and health information for a child enrolled in preschool
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Emergency Contact Vendor Form
PDF template
Form for collecting emergency contact details and medical information for vendors and booth operators.
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Emergency Contact Information Form
PDF template
A document for collecting employee emergency contact details and medical information for use in urgent situations.
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Health Office Emergency Contact Form
PDF template
A comprehensive form collecting student contact, medical, and insurance information for school emergency purposes.
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Emergency Contact Form
PDF template
A form for employees to provide emergency contact details for workplace safety and communication purposes.
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Volunteer Emergency Contact Form
PDF template
A form for collecting emergency contact information for volunteers in case of accidents or emergencies.
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Hickory Hill Member Family Emergency Contact Form
PDF template
A form for collecting emergency contact information and medical authorization for family members at a club or organization.
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Thorn Flats Emergency Contact Form
PDF template
A form for collecting student emergency contact information at Lincoln University's Residence Life office.
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EMERGENCY CONTACT FORM
PDF template
A form for collecting personal, emergency contact, and medical information for students in case of emergency situations.
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Emergency Contact Form
PDF template
A form for collecting emergency contact details and authorization for a child's guardians and emergency contacts.
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Business And Organization Emergency Contact Information
PDF template
A form for businesses to provide emergency contact details and authorization to police for premises enforcement
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U.S. Court Of Appeals Emergency Contact Form
PDF template
Form for collecting personal contact information and emergency contact details for U.S. Court of Appeals personnel.
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Fulbright Grantee Emergency Contacts
PDF template
Form for collecting emergency contact details for Fulbright grantees for safety and communication purposes.
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Emergency Contact Information
PDF template
A form for collecting employee emergency contact details and notification preferences for campus safety purposes.
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Emergency Coronavirus Paid Leave Request Form
PDF template
Form for City of Birmingham employees to request paid leave related to COVID-19 emergency situations
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Emergency Coronavirus Paid Leave Request Form
PDF template
Form for City of Birmingham employees to request emergency paid leave related to COVID-19 pandemic circumstances.
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Emergency Disaster Contact Form
PDF template
A form for child care facilities to provide emergency contact and operational status information during disaster situations.
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Emergency Contact Form
PDF template
A comprehensive form for recording family contacts, medical care providers, and insurance details for emergency reference.
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Emergency Information
PDF template
A comprehensive emergency contact and medical information form for students participating in university activities.
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Student Emergency Contact Form
PDF template
A form for collecting student personal details and emergency contact information for use in case of urgent situations.
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Emergency Paid Sick Leave Request Form For COVID 19 Related Leave
PDF template
A form for employees to request emergency paid sick leave related to COVID-19 under the Families First Coronavirus Response Act.
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EMERGENCY LOAN APPLICATION FORM
PDF template
A loan application form for members of the Nkaimura Welfare Group to request emergency financial assistance with specific repayment terms and guarantor requirements.
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Emergency Medical Form For Pre Clinical And Clinical Placements
PDF template
A form for clinical and pre-clinical teacher candidates to provide emergency medical and contact information for placement purposes.
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PADRE PIO ACADEMY EMERGENCY MEDICAL FORM
PDF template
A medical form for collecting student emergency contact and treatment authorization information for Padre Pio Academy.
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Emergency Medical Form
PDF template
A comprehensive form for collecting student medical information and emergency contact details with parental consent for medical treatment.
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Emergency Medical Treatment Form
PDF template
A comprehensive medical information form for emergency medical treatment and patient details, designed to be posted on a refrigerator for quick access.
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Emergency Medical Form
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Form for updating student emergency contact, insurance, and athletic participation information for school records.
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UW Stevens Point Summer Camps Emergency Procedures
PDF template
Comprehensive emergency response protocol for handling medical incidents and accidents during UW-Stevens Point summer camps
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EmergencyMedical Release Authorization Form
PDF template
A form authorizing school staff to seek medical treatment for a child in case of emergency and acknowledging parental responsibility for medical expenses.
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EmergencyMedical Release Authorization Form
PDF template
Authorization form allowing school staff to seek medical treatment for a child in emergency situations with parental consent.
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Emergency Medical Release Form
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A form granting permission for emergency medical treatment for a minor at Pats Peak Ski Area, authorizing medical care in case of illness or injury.
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Emergency Medical Release Form
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A comprehensive medical form for collecting health information and emergency contact details for participants in adaptive or therapeutic horseback riding programs.
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Emergency Medical Release Form
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A form authorizing school officials to consent to medical treatment for a minor in case parents/guardians cannot be reached.
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Emergency Paid Sick Leave Request Form
PDF template
A form for employees to request paid sick leave related to COVID-19 under the Emergency Paid Sick Leave Act.
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Emergency Contact Form
PDF template
A form for collecting participant contact details and emergency contact information for multiple potential contacts.
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Emergency Procurement Justification Request Form
PDF template
A form used to document and justify emergency procurement actions for urgent situations requiring immediate action.
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2022 Emergency Form
PDF template
Official form documenting emergency procurement procedures for state agencies in response to urgent public health, safety, or property threats.
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EMERGENCY PURCHASE FORM
PDF template
A form for documenting and authorizing emergency purchases of goods and services when standard procurement methods are not feasible.
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Emergency Purchase Form
PDF template
A document used to justify and document emergency procurement processes when standard bidding procedures cannot be followed.
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DUTCHESS COMMUNITY COLLEGE EMERGENCY MEDICAL FORM
PDF template
A consent form allowing medical treatment for a child during a summer program, with parental emergency contact authorization.
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Emergency Requisition Form
PDF template
A form used to obtain goods or services through expedited procedures during urgent or unforeseen circumstances that require immediate action.
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Emergency Response Template For FIRST Event Managers
PDF template
Comprehensive guide for event managers to prepare for and respond to potential emergency situations during FIRST events.
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Emergency Paid Sick Leave Request Form
PDF template
Form for employees to request emergency paid sick leave related to COVID-19 circumstances
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Clauses To Emergency Use Agreement
PDF template
Legal document outlining terms and conditions for emergency service provision between City of Dripping Springs/ESD #6 and a vendor during emergency situations.
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EmergencyMedical Authorization Waiver Form For Minor Participants
PDF template
A form authorizing emergency medical treatment and waiving liability for minor participants in a Ferris State University camp or program.
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Emeriti Retirement Health Solutions Personal Contribution Form
PDF template
A form for making personal contributions to an employer-sponsored retirement health plan managed by TIAA-CREF.
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Emeriti Reimbursement Benefit Claim Form
PDF template
Instructions for submitting healthcare reimbursement claims through Rx debit card, online portal, or paper submission.
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EMERGENCY MEDICAL FORM
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A form for parents to authorize emergency medical treatment for students and provide critical medical contact and health information.
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Emergency Quick Reference Guide
PDF template
A comprehensive guide for emergency procedures, safety reporting, and key contact information for the University of Arkansas for Medical Sciences (UAMS) campus.
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EMG ORDER FORM
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Medical referral form for ordering electromyography studies to diagnose nerve and muscle conditions.
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Health Insurance Claim Form
PDF template
Standard health insurance claim form for submitting patient and insurance information for medical reimbursement and processing.
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EXTERN EMERGENCY CONTACT FORM
PDF template
Form for collecting emergency contact details for external personnel or employees at a veterinary organization.
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EMPLOYEE EMERGENCY CONTACT FORM
PDF template
A form for employees to provide emergency contact information for use in case of urgent situations.
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EMPLOYEE EMERGENCY CONTACT FORM
PDF template
A comprehensive form for collecting employee personal and emergency contact details for human resources purposes.
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Employee Emergency Medical Form
PDF template
Confidential form for collecting employee emergency contact details, medical conditions, and treatment consent.
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ENROLLMENT, CHANGE, CANCELLATION, OR OPT OUT EMPLOYEES ONLY HEALTH AND WELFARE PLANS
PDF template
A form for Lawrence Livermore National Security employees to enroll, change, cancel, or opt out of health and welfare benefit plans.
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Employee Resource Document
PDF template
A comprehensive guide for University of Scranton employees detailing emergency contacts, campus resources, and essential operational information.
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M NCPPC Benefits EnrollmentChange Form
PDF template
Form for employees to enroll in or modify benefits, including medical, dental, and prescription plans.
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Employee And Dependent Tuition WaiverReimbursement Form
PDF template
Form for employees to request tuition waiver or reimbursement for themselves or dependents at SSU.
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Health Coverage Waiver Form
PDF template
A document allowing employees to waive health insurance coverage offered by their employer with options for alternative coverage.
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New Patient Intake Form
PDF template
Comprehensive medical form for collecting new patient health history, chronic conditions, surgical history, medications, and family medical background.
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APPLICATION FOR EMPLOYMENT
PDF template
Comprehensive employment application form for job seekers applying to La Rabida Children's Hospital.
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Application For Employment
PDF template
Employment application form for Logan County Health Services with instructions for completing the document electronically or manually.
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CENTER FOR EARLY EDUCATION AND CARE STAFF EMERGENCY CONTACT FORM
PDF template
A form for collecting emergency contact and medical information for staff members of an early education center.
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Request For Consultation
PDF template
A medical consultation request form for electron microscopy services, used to collect patient medical history, diagnostic information, and study details.
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EMS Payment Plan Form No Penalty No Interest
PDF template
A form for establishing an extended payment arrangement for ambulance billing with the City of Houston
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NEW PATIENT INTAKE FORM
PDF template
A comprehensive medical history form for new patients, capturing personal information, medical history, and current health concerns.
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Endocrinology Submission Form
PDF template
Comprehensive form for submitting veterinary endocrine and hormone function test samples with detailed diagnostic testing options.
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REFERRAL FORM
PDF template
A medical referral form for endocrinology patients, specifically focused on thyroid-related diagnoses and consultations.
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New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients at the UCSF Endometriosis Center, focusing on pain assessment and reproductive health.
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Energy Emergencies And Security Program
PDF template
A contact information form for utility companies to provide emergency and communication details for energy sector emergencies.
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ENGINE INSPECTION FORM
PDF template
Comprehensive inspection form for evaluating vehicle engine and equipment requirements for emergency response vehicles.
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Financial Assistance Application
PDF template
A comprehensive form for patients to provide financial details and income verification for potential medical financial assistance.
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Youth Programs Mandatory Forms
PDF template
Comprehensive legal document for youth program participation, covering travel, risk, and liability waivers for participants or their guardians.
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Home Health Referral Form
PDF template
A comprehensive form for referring patients to home health services, capturing patient information, medical orders, and healthcare practitioner details.
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ENJAYMO Patient Solutions Enrollment Form
PDF template
Comprehensive patient enrollment form for ENJAYMO patient assistance program, collecting personal and insurance information.
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Enrichment Program Proposal
PDF template
A form for submitting proposed educational enrichment programs to Rochester Community Schools for review and potential approval.
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Westtown Township Health And Wellness Registration And Insurance Form
PDF template
Registration form for Westtown Township's fitness programs including Pilates and Yoga, with health history and consent sections.
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Enrollment Transfer Request Form
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A form for veterans to transfer their medical enrollment between VA healthcare facilities, capturing personal and contact information.
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ENROLLMENT FORM NATIONAL ELEVATOR INDUSTRY BENEFIT PLANS
PDF template
An enrollment form for employees of the National Elevator Industry to enroll in benefit plans and update personal and dependent information.
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Electronic Consent Contact Form
PDF template
A consent form allowing patients to receive medical communications via email, SMS, and phone for allergy treatment updates and appointment reminders.
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Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, contact, medical, and insurance information for healthcare providers.
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Strathbungo Spring Fling Art Competition Entry Form
PDF template
Entry form for children aged 5-8 years to participate in a local art competition with parental permission required.
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LUCY IN SPACE CONTEST ENTRY FORM WITH PARENTAL CONSENT
PDF template
A creative contest for middle and high school students to engage with space exploration and NASA's Lucy Mission through art and writing.
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Health History Examination Form South Carolina Envirothon Program
PDF template
Comprehensive health and emergency contact form for documenting medical information and insurance details for program participants.
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Vermont Town Health Officer Complaint Inspection Form
PDF template
A standardized form for documenting health-related complaints and property inspections by local town health officers in Vermont.
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Release Of Liability, Promise Not To Sue, Assumption Of Risk And Agreement To Pay Claims
PDF template
A legal document that releases a university from liability for potential injuries or damages during an activity or related travel.
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Complaint Form For Filing A Protected Disclosure Of Improper Governmental Activities AndOr Significa
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A form for employees or applicants to report improper governmental activities or significant health and safety threats.
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Youth Sports Medical History Form
PDF template
A comprehensive medical history form for youth sports participants, requiring detailed health information and medical practitioner verification.
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Consulting Physician Compliance Form
PDF template
A comprehensive medical form for evaluating patient mental capacity and terminal disease status by consulting and attending physicians.
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Law Enforcement Officers Waiver Form
PDF template
Form for Law Enforcement Officers to waive enrollment privileges in the Public Employees' Retirement System (PERS)
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Disposition Authorities Frozen Under The Epidemiological Moratorium
PDF template
Comprehensive list of disposition authorities for health-related records under moratorium at the Department of Energy as of March 2008.
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Episodic Medical Form
PDF template
A comprehensive medical intake form for students to document current health issues and medical history at Ramapo College's Health Services.
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COVID 19 Emergency Paid Leave (EPL) Employee Notification And Leave Request Form
PDF template
Form for employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
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Emerging Printmakers Residency Application Form
PDF template
Application form for artists seeking a residency program at Print Arts Northwest for emerging printmakers.
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Accident Waiver, Release Of Liability And IndemnityHold Harmless Agreement For The Use Of Loaned Equ
PDF template
Legal document releasing White Lake Community Library from liability when borrowing and using library equipment
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Waiver And Release Agreement
PDF template
A document allowing student photography and releasing the school district from liability for potential harm or damages.
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ERaf Request Form
PDF template
A form used by specialists to request an electronic Request for Authorization Form (eRAF) from Primary Care Providers for specialty care.
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VR 200 ERAVE Electronic Registration Process Waiver Form
PDF template
A waiver form for medical certifiers in Arkansas seeking exemption from electronic record submission requirements for death certificates.
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College Of The Siskiyous Emergency Contact Form
PDF template
A form for collecting employee emergency contact information and contact preferences for information release.
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Employee Resource Document
PDF template
A comprehensive resource document for employees providing emergency contacts, academic information, and campus resources.
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Emergency Response Guidelines
PDF template
A comprehensive guide for responding to various campus emergencies and safety procedures for university community members.
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Emergency Ride Home (ERH) Reimbursement Form
PDF template
Form for employees to request reimbursement for emergency transportation home under specific qualifying circumstances.
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License Agreement
PDF template
A license agreement for artists submitting artwork to the Into the Pixel art exhibition, granting non-exclusive usage rights to the Entertainment Software Association.
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ESPEN RESEARCH FELLOWSHIPS 2020 APPLICATION FORM
PDF template
Application form for research fellowship funding from ESPEN, with detailed requirements for applicants and project details.
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ESRD Incident Or Accident Report Form
PDF template
A detailed reporting form for documenting critical incidents or accidents in healthcare facilities, especially for End-Stage Renal Disease (ESRD) centers.
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Community Grant Application Form
PDF template
A comprehensive application form for non-profit organizations seeking community grant funding for various programs and events in Estevan, Saskatchewan.
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MEDICAL HISTORY FORM
PDF template
A comprehensive medical history form for patients aged 12 and older, used in combination with a referral form and unique reference number (URN).
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Feedback Form
PDF template
Survey collecting feedback from TV writers and producers about CDC resource materials and tip sheets for health-related storytelling.
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EVENT FEEDBACK FORM
PDF template
A comprehensive survey to collect participant feedback about an event's quality, content, and overall experience.
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Events, Programs Special Projects Proposal Form
PDF template
A comprehensive form for submitting event, program, or project proposals at Seattle University School of Law with detailed guidelines and requirements.
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Ski Area Release Agreement
PDF template
Legal document waiving liability for ski-related activities at Lake Louise Ski Area, covering potential injuries and property damage.
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Waiver Form
PDF template
A legal document providing consent and releasing liability for participation in a St. Jude Children's Research Hospital event.
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Piercing Consent Release Form
PDF template
Legal document providing informed consent for body piercing procedures, detailing risks and patient acknowledgments.
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Volunteer Management Toolkit Health And Safety Information
PDF template
A comprehensive guide outlining health and safety responsibilities, reporting procedures, and expectations for volunteers in arts organizations.
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Release Of All Claims
PDF template
Legal release form for participants of a community garden, acknowledging risks and waiving liability for potential accidents or injuries.
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MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
PDF template
A comprehensive medical insurance claim form for submitting healthcare reimbursement or coverage information.
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Southwestern Community College District Excursion Liability Release Agreement Form
PDF template
A liability release form for students participating in off-campus activities or field trips sponsored by Southwestern Community College District.
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Primary Care EXERCISE CLINIC REFERRAL
PDF template
A medical referral form for patients seeking exercise physiology services, documenting health conditions and exercise participation eligibility.
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Exercise Waiver And Release Form
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A legal document releasing fitness facilities or trainers from liability for potential injuries during exercise activities.
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Catholic Identity Commitment Agreement
PDF template
Agreement defining the preservation of Catholic identity and ethical guidelines in the transfer of Catholic Medical Center's healthcare facilities to HCA.
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Simple Inquiry Form
PDF template
A form for documenting basic contact inquiries and program-related interactions.
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Supervisor Safety Accident Report Form
PDF template
A comprehensive form for documenting workplace accidents, injuries, and recommended corrective actions.
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Exhibition Booking Form
PDF template
Booking form for virtual exhibition participants at the 5th High-level Ministerial Meeting on Transport, Health and Environment
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Exhibition Inventory Form
PDF template
Document for tracking artwork details, lender information, and exhibition logistics for Murray State University art exhibitions.
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Exhibition Loan Inventory Form
PDF template
A form for documenting artwork details for loan to an exhibition, including artwork specifications and valuation.
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Liability Waiver Form
PDF template
A liability waiver form for exhibitors at conferences or events at the Hyatt Regency Newport, requiring insurance documentation and releasing Hyatt from potential claims.
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Voluntary Resignation Form
PDF template
Official document for employees resigning from their position at North Ogden City, including legal waivers and acknowledgments.
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G Adventures Confidential Medical Form
PDF template
A confidential medical form for travelers with pre-existing medical conditions to assess fitness for expedition travel.
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Emergency ResponsePublic Safety Worker Incident Report Form
PDF template
A form for emergency response and public safety workers to document workplace exposure incidents and medical referral details.
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Exposure Incident Investigation Form
PDF template
A form used to document and investigate workplace exposure incidents involving potentially infectious materials.
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Hazardous Exposure To Blood And Other Body Fluids
PDF template
Guidelines for managing accidental contact with human blood or body fluids in workplace and educational settings, including immediate response steps and responsibilities.
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Exposure Incident Investigation Form
PDF template
A detailed form for documenting and investigating workplace exposure incidents, including route of exposure, materials involved, and prevention recommendations.
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Form B Exposure Incident Report Form
PDF template
A form documenting potential medical exposure incidents for students during clinical training or placement.
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Texas City ISD Extended Leave Request Form
PDF template
A form for employees to request extended leave with medical certification, to be submitted to Human Resources.
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External Collaborator Requisition Form
PDF template
A form for documenting and tracking tissue sample shipments to the Human Tissue Resource Center at the University of Chicago.
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Laser Eye Examination Form
PDF template
Medical form for documenting laser user eye examination and medical history related to laser exposure risks.
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Eye Examination Waiver Form
PDF template
A form allowing parents/guardians to request a waiver for required student vision examinations due to access or financial barriers.
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Eye Examination Waiver Form
PDF template
A form for parents or guardians to request a waiver from required eye examination requirements for students in Illinois.
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EyewashDrench Hose Weekly Inspection Form
PDF template
Weekly safety inspection form for verifying proper functioning and accessibility of emergency eyewash stations in a workplace or laboratory setting.
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EYEWASH SHOWER INSPECTION RECORD
PDF template
A monthly inspection record for eyewash stations and safety showers in laboratory settings to ensure proper functioning and emergency readiness.
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Eyewash Weekly Inspection Form
PDF template
Weekly safety inspection form for verifying emergency eyewash station functionality and accessibility in workplace environments.
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Eyewash Weekly Inspection Form
PDF template
Weekly inspection form for verifying emergency eyewash station safety and functionality in workplace environments.
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CCP Prior Authorization Request Form
PDF template
A form for healthcare providers to submit prior authorization requests for medical services or treatments through Texas Medicaid Health and Human Services.
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LEAP Testing Service Sample Submission Form
PDF template
A form for submitting test samples to LEAP Testing Service for various scientific and medical testing purposes.
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Consent For Sterilization Completion Instructions
PDF template
Detailed instructions for completing a mandatory consent form for sterilization procedures under Wisconsin's ForwardHealth program.
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All Of Us Research Program Sample Consent Form
PDF template
A consent form for participating in a large-scale health research program funded by the U.S. government to collect health data from 1 million participants.
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WAIVER FORM REQUEST FOR SEPARATION RECORDS
PDF template
A form authorizing the release of law enforcement employment separation records to a prospective employer or the officer themselves.
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F245 145 000 Travel Reimbursement Request
PDF template
A form for workers to request travel expense reimbursement related to workers' compensation medical visits, treatments, or vocational services.
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Puget Sound Benefits Trust Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a short-term disability claim, requiring details from the employee, employer, and attending physician.
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Medical Dental Vision Prescription Weekly Disability Claim Form
PDF template
Comprehensive claim form for medical, dental, vision, prescription, and weekly disability benefits for NW Plumbers & Pipefitters Health Fund members.
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F 80 Application
PDF template
Application form for fire safety coordinators to verify fire alarm system competency in homeless shelters in New York City.
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Comprehensive Medical Examination Checklist
PDF template
A medical examination checklist for pilots seeking to operate small aircraft under BasicMed regulations in lieu of a third-class FAA medical certificate.
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One E App Health E Arizona
PDF template
An electronic application system for assistance programs supported by One-e-App software, used by FAA, AHCCCS, and authorized organizations.
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FCPRD Program Refund Policy
PDF template
Detailed guidelines for program fee refunds and emergency warning procedures in Fayette County Parks and Recreation areas.
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Contract Intelligence
PDF template
An advanced AI system for automated, high-precision extraction of key information from complex contracts using neuroscience-based technology.
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Domestic Academic Student Travel Waiver Form
PDF template
A legal waiver document for students participating in academic field trips or off-campus activities, outlining risk assumptions, medical consent, and vehicle use conditions.
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FACULTY LEAVE AND CLINIC CANCELLATION FORM
PDF template
A form for faculty members to request leave, vacation, or clinic cancellations in the Division of Endocrinology and Metabolism.
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Faculty Leave And Clinic Cancellation Form
PDF template
A form for faculty members to request leave, cancel clinics, and arrange coverage in the Division of Endocrinology and Metabolism.
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UNIVERSITY OF PUGET SOUND FACULTY LEAVE REQUEST FORM
PDF template
A comprehensive form for faculty members to request various types of leave, including medical, family, parental, and extended leaves.
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Faculty Led Programs Emergency Preparation, Emergency Procedures, Crisis Management
PDF template
Guidelines for emergency preparation and management for faculty-led educational programs, including pre-departure procedures and participant information collection.
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FAFSA Or DREAM ACT APPLICATION WAIVER FORM
PDF template
A form allowing students to opt out of filing FAFSA or DREAM Act financial aid applications while acknowledging their understanding of the applications.
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Westtown Township Health And Fitness Registration And Insurance Form
PDF template
Registration form for fitness programs with health history and medical information collection
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Community Gallery Proposal Form
PDF template
Application form for non-profit organizations seeking to exhibit artwork in a community gallery space
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Employee Medical Or Family Leave Of Absence Request Form
PDF template
A form for employees to request medical or family leave, indicating type and reason for absence
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Family And Medical Leave Request Form
PDF template
A comprehensive form for employees to request unpaid family and medical leave under federal FMLA guidelines, detailing leave entitlements and notice requirements.
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Family And Medical Leave (FML) Reference Chart
PDF template
Comprehensive reference guide for family and medical leave policies covering federal and California leave regulations for employees.
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Family Camp Medical Form
PDF template
Medical form for capturing health details and emergency contact information for families attending a camp
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Family Contact Form
PDF template
A form for collecting contact details for parents or guardians of a child or student.
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Family Contact Form
PDF template
Form for collecting comprehensive contact and insurance details for a client's family members and guardians.
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FAMILY EMERGENCY CONTACT FORM
PDF template
A comprehensive document listing essential emergency contacts and insurance information for family disaster preparedness.
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Family Emergency Plan
PDF template
A comprehensive document for recording family medical details, emergency contacts, and critical health information for emergency preparedness.
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NECAIBEW Family Medical Care Plan Family Enrollment Form
PDF template
An enrollment form for employees to enroll in the NECA/IBEW Family Medical Care Plan, including personal, spousal, and dependent information.
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YMCA OF ORANGE COUNTY Family Guides (Program Registration)
PDF template
Registration form for the YMCA Family Guides Program in Orange County, allowing families to sign up for program membership and events.
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Family Medical History Form
PDF template
A comprehensive form for documenting family medical history across multiple health conditions and genetic risks.
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Family Or Medical Leave Request Form
PDF template
A form for employees to request medical or family leave, including documentation of leave type and duration.
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Degree Evaluation Program Assessment Form
PDF template
A form for students to request evaluation of their academic program, course completion, and potential degree program changes.
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New Medical Form Consent Form FAQ
PDF template
Explanation of changes to Special Olympics Illinois medical documentation requirements including new Medical Form and Consent Form procedures.
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Farm Emergency Contact Form
PDF template
A comprehensive emergency contact and insurance information form for farm operations, listing critical emergency and support service contacts.
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Farm Emergency Contact Form
PDF template
Comprehensive form for documenting emergency contacts, insurance policies, and critical service providers for a farm operation.
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42314 Webinar Fast Track Medicaid For SNAP Participants Submitted QA
PDF template
A document providing questions and answers about Medicaid enrollment options for SNAP participants across different states.
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Voluntary Waiver Form
PDF template
A form for requesting a reduced Facilities and Administrative (F&A) cost rate for research proposals at UNTHSC.
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FAX REFERRAL FORM
PDF template
A medical referral form for patients seeking low vision rehabilitation services in Colorado.
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Urogynecology New Patient Intake Form
PDF template
Comprehensive medical intake form for urogynecology patients to document urinary and bowel symptoms, medical history, and patient goals.
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Employee Voluntary Waiver Form
PDF template
A form allowing employees to voluntarily waive employer health care expenditures if they receive health coverage through another employer.
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INCLUSA CLAIM FORM
PDF template
A claim form for submitting healthcare service claims to Inclusa Family Care through WPS Health Insurance.
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BioDynamic Manual Therapy, LLC Patient Questionnaire
PDF template
Comprehensive medical intake form for collecting patient health history, current symptoms, and personal health details
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EMERGENCY CONTACT FORM
PDF template
A form for collecting emergency contact details for tenants in a building, to be used by property management in case of emergencies.
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LSU Faculty Dental Practice Medical History Form
PDF template
Comprehensive medical history form for patients at LSU Faculty Dental Practice, collecting personal health information and medical background.
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FD Written Approval For Burn, V.1 42019
PDF template
A form that provides fire department approval for landowners to conduct open burns during otherwise prohibited hours in Ohio.
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Declared Emergency For February 2024 Storm And Flooding
PDF template
Official document providing emergency resources and damage reporting guidance for counties impacted by February 2024 storms in California.
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Example Of Fellowship Application Form
PDF template
A comprehensive application form for fellowship candidates in preventive cardiology or related medical disciplines.
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MSKCCWeill Cornell Procedural Dermatology Fellowship Application
PDF template
Application form for fellowship in Procedural Dermatology at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical Center.
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MSKCCWeill Cornell Procedural Dermatology Fellowship Application
PDF template
Application form for a procedural dermatology fellowship at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medicine.
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CIRSE Fellowship Information And Application
PDF template
Comprehensive guidelines for physicians and scientists seeking CIRSE Fellowship status in interventional radiology and cardiovascular imaging.
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Standardized Application For Pathology Fellowships
PDF template
Comprehensive application form for pathology fellowship candidates covering personal details, education, and fellowship preferences.
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FEMA TENDER OF SERVICE PROGRAM TRANSPORTATION SERVICE PROVIDER (TSP) REGISTRATION FORM
PDF template
A form for transportation companies to register and become approved providers for FEMA emergency logistics services
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Publication Order Form
PDF template
Form for ordering publications from the Federal Emergency Management Agency through email, phone, or fax.
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FEMA Tender Of Service Program Transportation Service Provider (TSP) Registration Form
PDF template
Registration form for transportation service providers seeking approval to work with FEMA during emergency logistics and response operations.
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Patient Intake Form
PDF template
Comprehensive intake form for collecting patient personal, contact, and medical background information with emphasis on privacy and demographic details.
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Health Benefits Claim Form
PDF template
A comprehensive form for submitting health insurance benefits claims, including patient and insurance information.
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FERPA Waiver Form
PDF template
A form allowing students to grant access to their academic records to specified individuals at West Virginia University at Parkersburg.
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Nebraska FFA Association Medical Release Form
PDF template
A comprehensive medical consent and emergency contact form for FFA members, allowing parental consent for medical treatment and providing essential health information.
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FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA) LEAVE REQUEST FORM
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act for various COVID-19 related reasons.
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ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
PDF template
A comprehensive legal document that releases liability for participants in various group activities and events.
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FHNO Indus Institutional Fellowship (FIIF) Application Form 2024
PDF template
Application form for medical professionals seeking to apply for the FHNO Indus Institutional Fellowship for the 2024 batch.
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Fora Health Residential Referral Form
PDF template
Comprehensive referral form for admitting patients into Fora Health's residential treatment program with detailed guidelines and requirements.
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Preparticipation Physical Evaluation Medical History Form
PDF template
Comprehensive medical history form for students participating in sports, requiring detailed health information and medical evaluation
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Medical History Form
PDF template
Comprehensive medical history and health screening form for student-athletes to assess fitness for sports participation
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Student Health Insurance Waiver Form
PDF template
Form for students to request a waiver from the university's mandatory student health insurance plan by proving alternative health coverage.
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Field Guide Assessment Form
PDF template
A comprehensive form for documenting and assessing emergency situations affecting collections or sites, with detailed survey information.
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Release Of Liability, Waiver Of Right To Sue, Assumption Of Risk And Agreement To Pay Claims
PDF template
A legal document that releases California State University from liability for potential injuries or damages during an activity or event.
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Release Of Liability, Waiver Of Claims, Express Assumption Of Risks, And Hold Harmless Agreement
PDF template
Legal document releasing Florida Atlantic University from liability for potential risks and damages during a field trip.
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FIELD TRIPTRANSPORTATION PERMISSION AND WAIVER FORM
PDF template
A legal document granting permission for student participation in a field trip while releasing the school from potential liability.
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Adult Tuberculosis (TB) Risk Assessment Questionnaire
PDF template
A medical screening form for assessing tuberculosis risk in adults, required by California Education and Health Codes.
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YMCA Camp Independence 2024 Health History And Examination Form
PDF template
Medical form for collecting camper health information and emergency contact details for YMCA summer camp participation.
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Address Assignment Application
PDF template
Application for obtaining an official address within Elmore County's E-911 grid system to assist emergency personnel in locating properties.
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ADDRESS ASSIGNMENT APPLICATION
PDF template
Application for obtaining an official address within Elmore County's E-911 grid system to assist emergency personnel in locating a property.
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Artist Release, Waiver Of Liability Loan Agreement
PDF template
Legal document outlining terms for an artist loaning artwork to the Children's Museum of Oak Ridge for a temporary exhibition.
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Companion Agreement Form
PDF template
A form for requesting the use of a companion during participation in Prince George's County Parks and Recreation programs and events.
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Patient Demographics Form
PDF template
Comprehensive medical intake form collecting patient personal, contact, insurance, and consent information for healthcare services.
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Parental Consent And Waiver Form For Minor Students
PDF template
A consent form for parents/guardians allowing minor students (17 or younger) to enroll in Lone Star College courses with specific terms and conditions.
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Declaration Of Academic Program
PDF template
Academic form for students to declare their career and technical degree or certification program at ECC.
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DOTM FORM 1024 FFCRA SICK LEAVE REQUEST
PDF template
A form for employees to request paid sick leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
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Enrollment Form
PDF template
Comprehensive form for enrolling a child in childcare, collecting personal information, emergency contacts, and health details.
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InternExtern Application Packet
PDF template
Application for internship and externship opportunities at Elica Health Centers, focusing on medical, dental, and behavioral health fields.
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Humboldt County Referral Initiative Referral Form
PDF template
A comprehensive medical referral form for transferring patient information between healthcare providers with multiple referral type options.
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Volunteer Orientation
PDF template
A comprehensive orientation document for college students interested in volunteering at a physical therapy clinic to gain healthcare experience and learn about the profession.
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Volunteer Indemnity Agreement
PDF template
Legal document indemnifying Bay Cliff Health Camp against liability for volunteer injuries or losses during camp activities.
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Patient Medical History And Symptoms Form
PDF template
A detailed medical intake form capturing patient demographics, ethnicity, race, symptoms, and previous diagnostic studies and treatments.
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Medical Report Health Statement And Immunizations For 2023 2024
PDF template
Medical form for documenting student health status and required immunizations for St. Paul's School enrollment
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Medical Freeze Request Form
PDF template
A form for requesting a temporary freeze on a membership due to medical reasons with specific conditions and documentation requirements.
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MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form for capturing patient health information, medical conditions, lifestyle factors, and current health concerns.
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Medical Information Form
PDF template
A comprehensive medical form for students to provide health information, medication details, and parental consent for school medical procedures.
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2024 25 PermissionWaiver Emergency Information Form Minor
PDF template
A comprehensive form for minor participants to provide emergency contact information and release liability for church activities
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Naturopathic Patient Intake Form
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Comprehensive intake form for new patients seeking naturopathic medical consultation, collecting detailed personal and health history information.
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NEW CLIENT INFORMATION PAYMENT AGREEMENT
PDF template
A veterinary hospital intake form for new clients to provide personal and pet information along with payment terms.
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New Patient Intake Form
PDF template
Comprehensive intake form for new patients seeking cosmetic procedures, collecting personal information and medical history.
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FILLABLE ORDER FORM FOR SFP 7 17 CURRICULUM AND MATERIALS
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Order form for purchasing Strengthening Families Program curriculum materials and resources for the 7-17 age group.
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Osteopathy Patient Intake Form
PDF template
Comprehensive medical intake form for osteopathic patient assessment and medical history documentation.
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Patient Information For Appointment Booking
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A comprehensive patient intake form for medical appointment booking at Peninsula Gastroenterology, collecting personal and medical contact details.
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PATIENT REFERRAL FORM
PDF template
A comprehensive form for referring veterinary patients to specialized veterinary services and departments.
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Patient Registration Form
PDF template
Comprehensive medical intake form for collecting patient personal information, emergency contact details, insurance information, and health history.
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Pharmacy Payment Plan Agreement
PDF template
Payment agreement form for managing pharmacy account balances and establishing payment schedules for outstanding medical charges.
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Arizona JKA 2024 Summer Payson Camp Waiver Form
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Legal document releasing liability for participation in martial arts training and activities, acknowledging inherent risks of physical injury.
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PATIENT INTAKE FORM
PDF template
Comprehensive medical form for collecting patient health history, contact information, and medical background details.
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Patient Discharge Form
PDF template
A standardized form for documenting patient discharge details, treatment status, and medical recommendations.
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Santee Recreation Registration Form
PDF template
Registration form for participants to sign up for recreation activities in the City of Santee, including personal and medical information.
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Sports Participant Waiver Form
PDF template
Legal waiver for participants in sports activities, releasing the organization from liability for potential injuries or damages.
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Summer Camp Registration And Waiver Form
PDF template
Waiver and release form for participants in Colorado Mesa University Tech summer camp program, acknowledging risks and releasing liability.
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Immunization Consent Form
PDF template
A comprehensive form for collecting patient demographic, insurance, and consent information for immunization services.
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Waiver Form
PDF template
A liability waiver form for user groups utilizing School District No. 5 (Southeast Kootenay) properties and facilities.
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CLARK COUNTY SCHOOL DISTRICT VOLUNTEER WAIVER AND RELEASE
PDF template
Legal document releasing Clark County School District from liability for volunteer activities and potential risks during service.
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Healthcare Forms Catalog
PDF template
Comprehensive list of medical forms and clinical documentation used across various healthcare departments and specialties.
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Paths To Health NM Tools For Healthier Living Referral Form
PDF template
A referral form for participants to join Paths to Health NM health programs with provider contact information.
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Financial Assistance Application Form
PDF template
A confidential form for patients seeking financial assistance, requiring detailed personal and income information for healthcare services.
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Financial Assistance Evaluation
PDF template
Application form to help patients determine eligibility for free or discounted healthcare services and public assistance programs.
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Suburban Urologic Associates Financial Policy
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Detailed financial policy outlining insurance, payment, and billing procedures for a urology medical practice.
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Type 2 Diabetes Risk Assessment Form
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A comprehensive questionnaire to assess an individual's risk of developing type 2 diabetes within the next 10 years.
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VEHICLE ACCIDENT REPORTING
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Detailed procedure for reporting and managing vehicle accidents involving Phoenix Fire Department vehicles, including notification protocols and scene management.
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Health Care Facility Fire Incident Report
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A comprehensive form for documenting fire incidents in healthcare facilities, tracking details about the fire, casualties, damage, and prevention strategies.
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ENGINEERING FIRE RISK ASSESSMENT (FORM 24309)
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A comprehensive document for assessing fire risk across multiple environmental and geographical factors.
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First Aid Policy
PDF template
A comprehensive policy outlining first aid requirements, responsibilities, and procedures for ensuring health and safety in school settings.
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First Aid Report Form
PDF template
A comprehensive form for documenting first aid incidents, medical assessment, and treatment details for a single victim.
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First Book Liability And Media Release Form
PDF template
A legal document providing liability waiver and media release for participants in First Book events, particularly for minors.
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First Time Appointment Billing Form
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A billing form for documenting client details, service type, and appointment information for a first-time healthcare consultation.
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Fisher House Of The Emerald Coast, Inc. Edible Art Cake Decorating Contest General Competition And
PDF template
Competition guidelines for an annual cake decorating contest with a superhero theme, hosted by Fisher House of the Emerald Coast.
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Management Benefits Fund (MBF) Health And Fitness Reimbursement Program Claim Form
PDF template
A form for MBF members to claim reimbursement for health and fitness expenses for themselves and their spouse/domestic partner.
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HealthFitness Center Reimbursement Form
PDF template
A form for Capital Health Plan members to request reimbursement for health and fitness center memberships up to $150 per family or member.
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Fitness Studio Membership Form
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A membership form for joining the Wood Dale Park District Fitness Studio with membership options and liability waiver.
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Standard Immunization Requirements For Admission To U.S. Schools
PDF template
A comprehensive medical form documenting vaccination history and requirements for students entering U.S. schools or programs
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MEDICAL FLEX REIMBURSEMENT FORM
PDF template
A form for employees to request reimbursement for medical and dental expenses through a flexible spending account program.
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Work Order To Physical Plant To Correct Safety Needs
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Procedure for reporting and managing campus accidents, injuries, and safety incidents at Texas A&M University-Corpus Christi.
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MINORS ONLY FLOWRIDER ARBITRATION AGREEMENT
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Legal document outlining risks and arbitration terms for minors participating in the FlowRider water amusement ride.
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FLUOROSCOPY AND INTERVENTIONAL REQUISITION
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Comprehensive form for requesting medical imaging procedures, capturing patient details, medical history, and clinical information.
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Flu Vaccine Form
PDF template
A comprehensive form for patient consent and medical screening prior to receiving a flu vaccine.
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Hope College Student Contact And Health Insurance Information Form
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A comprehensive form for collecting student personal contact details, parent/guardian information, and health insurance details for Hope College admissions.
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Informed Consent To Body Pierce
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Legal form for obtaining patient consent and documentation for body piercing procedures in Wisconsin.
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Informed Consent To Tattoo Procedure
PDF template
A legal form for documenting informed consent and required patron information before receiving a tattoo procedure in Wisconsin.
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TEST REQUISITION FORM
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Medical test requisition form for transplant patient diagnostic testing with comprehensive patient and billing information collection.
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Hospital Discharge Plan For Tuberculosis Patients
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Comprehensive discharge planning document for patients being treated for tuberculosis, including medical details and follow-up instructions.
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FMLA Leave Request Form
PDF template
A form for employees to request Family and Medical Leave Act (FMLA) leave, outlining eligibility requirements and leave types.
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Requisition For Laboratory Supplies
PDF template
A form for requesting laboratory media, collection kits, supplies, laboratory forms, and reagents from Sacramento County Public Health Laboratory.
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Employee FMLA Leave Request
PDF template
Form for employees to request job-protected leave under the Family and Medical Leave Act (FMLA) for various family and medical reasons.
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FMLA LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request leave under the Family and Medical Leave Act for various personal and family medical situations.
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FMLA Leave Request Form
PDF template
A form for Harnett County employees to request Family and Medical Leave Act (FMLA) protected leave for various qualifying reasons.
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Family And Medical Leave Request
PDF template
Employee form for requesting job-protected medical or family leave under the Family and Medical Leave Act (FMLA)
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FAMILY OR MEDICAL LEAVE REQUEST FORM
PDF template
A form for employees to request family or medical leave for various personal and family health-related reasons.
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FMLA LEAVE REQUEST FORM
PDF template
A form for employees to request leave under the Family and Medical Leave Act for various personal and family health-related reasons.
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HR FMLAOFLA Leave Request
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A comprehensive form for employees to request leave under Family and Medical Leave Act (FMLA) and Oregon Family Leave Act (OFLA)
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Family And Medical Leave (FML)Paid Parental Leave (PPL) Request Form
PDF template
A form for employees to request family and medical leave or paid parental leave, including various qualifying reasons for absence.
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Family And Medical Leave Request
PDF template
Request form for employees seeking job-protected leave under the Family and Medical Leave Act (FMLA) for medical or family reasons.
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Family Medical Leave Request Form (FMLA)
PDF template
Form for employees to request Family and Medical Leave for various personal and family health-related reasons.
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Incident Report Form
PDF template
A comprehensive form for documenting incidents, injuries, and damages at farmers markets with contact and emergency information.
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Incident Report Form
PDF template
A comprehensive form for documenting accidents, injuries, or incidents occurring at farmers markets.
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FARTHEST NORTH PICKLEBALL CLUB MEMBERSHIP FORM
PDF template
Membership registration form for the Farthest North Pickleball Club with liability waiver and annual dues information.
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JANDAKOT AIRPORT HOLDINGS HAZARD REPORT FORM
PDF template
A form for reporting safety hazards and potential risks at Jandakot Airport, used by tenants, employees, and visitors to document safety concerns.
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Food Establishment Inspection Report
PDF template
Official inspection report for evaluating food service establishments' compliance with health and safety regulations.
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Food Label Approval Form
PDF template
A form used by the Rhode Island Department of Health for reviewing and approving food product labels.
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FOOD POLICY WAIVER OF LIABILITY FORM
PDF template
A form for event organizers to acknowledge responsibility for food preparation, safety, and liability when catering non-university events.
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MOBILE FOOD SHOWER SERVICE REQUEST FORM
PDF template
Form for requesting mobile food and shower services during emergency incidents or response operations.
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ANNEX B Attendance Form
PDF template
A comprehensive form to capture demographic and professional details of participants in Food Systems Summit Dialogues to assess inclusivity and diversity.
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NHDP Form 133 Foot Evaluation
PDF template
Comprehensive medical form for assessing foot condition, nerve function, sensation, and risk categorization.
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FOOT Medical And Insurance Form
PDF template
Medical and insurance form for participants in the Yale First-Year Outdoor Orientation Trips (FOOT) program, collecting health and emergency contact information.
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Accident Waiver And Release Of Liability Form
PDF template
Legal document releasing St. Vincent de Paul from liability for potential injuries during charity walk/run event
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FORAY CHECK INCHECK OUT FORM
PDF template
Waiver and check-in form for participants in mycological society mushroom forays, capturing participant details and liability release.
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Student Travel Profile General Liability Waiver
PDF template
A comprehensive waiver and medical procedure document for students participating in a mission trip, covering liability release and medical emergency protocols.
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International Travel Waiver Form
PDF template
A consent form allowing parent/guardian permission for a minor to participate in an international travel event, including liability release and emergency medical consent.
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Foresight Carrier Screen Requisition Form
PDF template
A medical form for requesting genetic carrier screening, collecting patient and clinic information, and processing billing details.
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LASER DEVICE REGISTRATION FORM
PDF template
Official form for registering laser devices with the Florida Department of Health Bureau of Radiation Control.
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Health And Immunization Form
PDF template
Comprehensive health form required for all undergraduate students detailing medical history, immunizations, and emergency contact information.
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NEW PATIENT INSURANCE AND OFFICE POLICIES CONSENT FORM
PDF template
A comprehensive form for collecting patient personal, insurance, and medical history information for dental office registration.
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2024 25 On Campus Housing And Dining Contract Waiver Form
PDF template
A form for Iowa State University students to request a housing contract waiver for academic programs outside Ames.
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Johnson Wales University Health Services Requirements
PDF template
Comprehensive health documentation and vaccination requirements for new students enrolling at Johnson & Wales University
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Form 350 Emergency Medical Service Provider Exposure Report Form
PDF template
A form to document exposure to blood and body fluids for emergency medical service providers, tracking details of potential occupational health incidents.
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Form No. 49AA Application For Allotment Of Permanent Account Number
PDF template
Official form for obtaining a Permanent Account Number (PAN) for non-Indian citizens, foreign entities, or entities formed outside India.
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Form No. 49A Application For Allotment Of Permanent Account Number
PDF template
Official application form for obtaining a Permanent Account Number (PAN) for Indian citizens, companies, and entities
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Form No. 49A Application For Allotment Of Permanent Account Number
PDF template
Official application form for obtaining a Permanent Account Number (PAN) for Indian citizens, companies, and entities.
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HFM Study Form 607 Mailing Blood To NIDDK DNA Repository Form
PDF template
A form for mailing blood samples to the NIDDK DNA Repository with specific shipping and tracking instructions.
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Form 6.4.2.2 Rev. D Service Request Form
PDF template
A form for submitting medical devices for service or repair, requiring verification of decontamination and cleaning.
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Acceptance Of Site Specific Health And Safety Plan (SSHASP) Form
PDF template
Internal form for documenting compliance and acceptance of a contractor's site-specific health and safety plan by an NJSDA Field Compliance Inspector.
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Adult Recreation Programs Release, Indemnification Medical Form
PDF template
Legal release and assumption of risk form for adult participants in Bainbridge Island Metropolitan Park & Recreation District programs.
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Alaska Travel Declaration Form
PDF template
Required form for travelers entering Alaska, documenting health status and travel details during COVID-19 pandemic.
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UAB Department Of Obstetrics And Gynecology Presentation Evaluation Form
PDF template
A form for evaluating the effectiveness of presentations within the UAB Obstetrics and Gynecology department.
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Medical Claim Form
PDF template
A comprehensive form for submitting medical claims and patient information to Anthem Blue Cross and Blue Shield insurance plan.
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OBGYN Formative Feedback Form
PDF template
A comprehensive evaluation form for tracking medical student performance in OBGYN clinical rotation, covering multiple professional and clinical competencies.
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Health Exam Form B
PDF template
A medical form for student athletes to obtain health clearance for participation in school athletic activities in Utah.
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Credit Card Pre Authorization ACH Pre Authorization Form
PDF template
A form allowing patients to pre-authorize credit card or bank account charges for medical services and outstanding balances.
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SEIU Michigan Health And Welfare Fund MemberS Change Of Address Form
PDF template
A form for SEIU Michigan Health and Welfare Fund members to update their personal and employment information.
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Medical ControlPhysician Contact Hour Attendance Form
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Tracking form for medical personnel to document attendance and details of training sessions for emergency medical services.
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Form C Student Waiver Form
PDF template
A legal document outlining conditions and medical treatment provisions for students performing services at Rutgers University.
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ART APP SUBMISSION FORM
PDF template
A form for students to submit artwork or app concepts for a university challenge competition.
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FMLA LEAVE REQUEST FORM
PDF template
A form for employees to request family or medical leave, documenting leave details and employee information.
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Maryland Schools Record Of Physical Examination
PDF template
Document outlining physical examination, immunization, and blood lead testing requirements for students entering Maryland public schools.
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COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave related to COVID-19 situations and circumstances
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Form I 690 Instructions
PDF template
Instructions for immigrants seeking a waiver of certain inadmissibility grounds from U.S. Citizenship and Immigration Services.
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Physical Examination Form
PDF template
Medical form for students at American School of Warsaw to document health status and medical clearance for school attendance and sports participation.
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FORM K FIELD TRIP LIABILITY WAIVER FOR ADULTS
PDF template
Legal waiver form for adult participants on field trips, releasing liability for the diocese and associated organizations.
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Medical History Form
PDF template
Required medical history form for students living on campus or participating in sports, documenting health conditions and physical readiness.
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Nebraska FBLA Medical Release Form
PDF template
A medical release and emergency contact form for Future Business Leaders of America (FBLA) chapter members during events or activities.
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Nebraska FBLA Medical Release Form
PDF template
Medical consent and emergency information form for FBLA chapter members, providing authorization for medical treatment and contact details.
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NEW PATIENT INTAKE FORM
PDF template
Comprehensive medical form for collecting new patient personal, contact, and demographic information for healthcare providers.
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Physical Examination
PDF template
A comprehensive medical examination form for girls participating in multi-day trips, documenting health status and medical clearance.
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Child Information Form
PDF template
A comprehensive form for collecting detailed personal and contact information about a child and their parents/guardians.
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Patient Registration
PDF template
A comprehensive medical patient registration form for collecting personal, contact, and insurance information for a dental practice.
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Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient personal and health information prior to medical treatment.
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Financial Agreement Appointment Reminders
PDF template
A comprehensive financial agreement outlining patient payment responsibilities, insurance billing, and appointment policies for counseling services.
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Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient personal and health information for medical treatment purposes.
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OBSTETRICAL Service Request Form
PDF template
Medical service request and authorization form for obstetrical services, used for processing healthcare claims and approvals
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Health Care Personnel (HCP) Baseline Individual TB Risk Assessment
PDF template
A screening form to evaluate tuberculosis risk factors for healthcare personnel
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PRESCRIPTION ORDER FORM
PDF template
A form for obtaining physician authorization for reimbursement of healthcare products and services requiring medical prescription.
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Transfer Request Form
PDF template
A form for requesting transfer of patient medical records to a new healthcare provider or facility.
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RESIDENCY APPLICATION FORM UDA 2023
PDF template
Application form for artistic residency program with comprehensive project submission requirements.
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AiR Goyki 3 Residency Application Form
PDF template
Application form for artists seeking a residency program at Goyki 3, requiring project proposal, portfolio, and CV submission.
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Health Care Program For Children In Foster Care (HCPCFC) Foster Care Medical (Specialty) Contact For
PDF template
A form for healthcare providers to document medical services and assessments for children in the foster care system.
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Contribution Form
PDF template
A charitable donation form for contributing to various healthcare-related funds and programs at Stormont Vail Foundation.
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Laboratory Requisition Form
PDF template
A comprehensive laboratory form for collecting patient blood samples and requesting various medical tests.
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Faith Pharmacy New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients at Faith Pharmacy, collecting personal, insurance, and medical information.
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Notice Of Hearing And Waiver Form
PDF template
A legal document for notifying parents and children of a juvenile court hearing and obtaining their consent for service of notice.
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FPU 4.004 Procedure For Payment, Waiver And Refund Of Tuition, Fees, Fines, And Penalties
PDF template
Policy governing tuition assessment, registration periods, and late registration fee waivers at Florida Polytechnic University.
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PATIENT INTAKE FORM
PDF template
Comprehensive medical history and current health status form for patient therapy intake and medical assessment.
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Free Medical Clinic Volunteer Application
PDF template
Application form for volunteers interested in working at a free medical clinic, requiring background checks and professional license verification.
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4th Annual Fremont County Fine Art Exhibit Application
PDF template
Application for local artists in Fremont County to participate in an annual fine art exhibition at Robert A. Peck Gallery.
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Resident FreshmanSophomore Parking Waiver
PDF template
A form for freshman and sophomore students to request a parking waiver at Hampton University based on specific circumstances.
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Inmate Medication Information Form
PDF template
A comprehensive medical form capturing medication history, psychiatric treatment details, and contact information for incarcerated individuals.
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NEW PATIENT INTAKE FORM
PDF template
A comprehensive form for new pharmacy patients to provide contact, medical, and medication preferences.
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Volunteer Form Release Of Claims
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Legal release form for volunteers participating in activities with Friends of the Blue Ridge Parkway, covering volunteer responsibilities and liability waivers.
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Consent For COVID 19 Immunization
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A consent form for COVID-19 immunization at Alberta Health Services, to be used when a parent or alternate decision-maker cannot be present with the person being immunized.
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Amprion Clinical Laboratory Test Requisition Form
PDF template
Laboratory test request form for collecting patient information, test details, and diagnostic information for Amprion Clinical Laboratory.
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Amprion Clinical Laboratory Test Requisition Form
PDF template
Medical laboratory test request form for collecting patient, billing, and diagnostic information for laboratory testing.
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Medical Reimbursement Form
PDF template
A comprehensive checklist for submitting medical reimbursement claims to Mass General Brigham Health Plan, detailing required documentation and submission process.
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Incident Report Form
PDF template
A comprehensive form used to report serious incidents, breaches, injuries, or emergencies within an organization or chapter.
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FAMILY FIRST CORONAVIRUS RESPONSE ACT (FFCRA) OREGON FAMILY LEAVE ACT (OFLA) LEAVE REQUEST FORM
PDF template
A form for employees to request leave under FFCRA and OFLA due to COVID-19 related circumstances
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EMS DUTY OFFICER Provider Feedback Form
PDF template
A form used by Montgomery County Fire and Rescue Services to document and evaluate emergency medical service provider performance and incident details.
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Health And Dependent Day Care Reimbursement Form
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Form for submitting health care and dependent day care expense claims under a Section 125 Cafeteria Plan for reimbursement.
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Fit Strong Data Collection Checklist
PDF template
Comprehensive checklist for leaders to manage Fit & Strong! workshop registration, participant tracking, and data collection processes.
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WA DNR Finance Envelope Documentation Requirement
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Detailed documentation requirements for fire district equipment and resources during emergency incidents both within and outside home regions.
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NERV Traveler Rental Vehicle Checklist
PDF template
A form for documenting vehicle rental details and driver responsibilities during emergency response operations.
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Text, E Booking E Mail Consent Form
PDF template
Patient consent form outlining risks and conditions for electronic communication with healthcare providers.
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Fraser Street Medical Clinic New Patient Registration Form
PDF template
Comprehensive medical intake form for new patients collecting personal information, medical history, and current health symptoms.
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Medical Release For Training Programs
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Policy outlining medical clearance requirements for students participating in firefighter training programs with strenuous activities.
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CareDx Transplant Test Requisition Form
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Medical form for ordering transplant-related diagnostic testing with patient and clinical information details
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CareDx Lung Transplant Test Requisition Form
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Medical form for ordering diagnostic testing for lung transplant patients, used to track patient information and test requirements.
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Discharge Form
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A comprehensive form for tracking patient discharge details, follow-up care, and medical conditions in a healthcare setting.
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Funeral Home Reimbursement Form
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Form for reimbursing funeral homes for additional costs associated with preparing and reconstructing organ, tissue, or eye donors for family viewing.
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MEDICAL HISTORY FORM
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Comprehensive form for collecting patient personal information, medical history, and dental visit details
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Pre Authorization Form
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Medical form for patients seeking insurance pre-authorization for hospital treatment, documenting patient and medical details for insurance approval.
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Maryland Statewide Medical Assistance Transport TransferDischarge Form
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A county health department form for documenting medical transportation needs and patient transfer details for medical assistance recipients.
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School Fee Waiver Application
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Application for students to request waiver of school-related fees based on specific eligibility criteria such as income, public assistance, or special circumstances.
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Program Solicitation Sound Health Network
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Grant proposal guidelines for a program exploring connections between music, neuroscience, and health research and wellness
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Patient Interview Form
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Comprehensive medical intake form for collecting patient demographic, health history, and contact information.
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GAANN Fellowship Application Form
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Application form for GAANN Fellowship at FIU, focused on AI and Cybersecurity research doctoral programs.
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Gannon University Health Examination Form
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A comprehensive health form required for students to access university health services and on-campus housing at Gannon University.
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New Patient Inquiries
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Comprehensive guide for new patients to register and schedule an appointment with the Geriatric Assessment Program at University of North Texas Health Science Center.
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Gastrointestinal Order Form
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A comprehensive medical order form for managing student's gastrointestinal, feeding, suction, catheterization, and ostomy care needs during the school year.
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PATIENT MEDICAL HISTORY FORM
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Comprehensive medical history form for patients at Gateway ENT to collect personal health information, medical history, and family health background.
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Gateway To Nucala Enrollment Form
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Enrollment form for healthcare providers to prescribe and administer Nucala medication, including prescriber and clinical information.
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GCAA Form 7 Liability Waiver Form
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A liability waiver form for student athletes participating in GCAA athletic events, requiring parent or guardian signature.
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Authorization Disclosure Of Confidential Information
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A form authorizing the release of confidential medical information to a specified healthcare facility with patient consent and time-limited authorization.
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Global Counseling Patient Intake Form
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Comprehensive medical intake form for counseling services, collecting patient personal and insurance information.
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Florida GED Testing Program Underage Waiver Form
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Form allowing students aged 16-17 to take the GED exam under specific district school board requirements.
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Medical Claim Form
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Comprehensive guide for completing and submitting medical insurance claims to GEHA, including instructions for in-network and out-of-network claims.
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Application Form
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Multi-purpose application form for volunteer, internship, independent study, and temporary employee positions at University Galleries.
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YMAHE Health Assessment Form
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Comprehensive health assessment form for first-year students requiring medical history, vaccination records, and physical examination details.
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Liability Waiver Form Stained Glass Workshop
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A legal document outlining safety procedures and liability release for participants in stained glass classes at MOCA and SHill Creations Studio.
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Bridge To Wellness Wellbeing Program General Medical Form
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WAIVER OF LIABILITY PERMISSION MEDICAL RELEASE FORM
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A liability waiver and medical release form for students staying overnight in a Mount Holyoke College residence hall, covering medical consent and risk acknowledgment.
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GeneralOffice Inspection Checklist
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A comprehensive checklist for periodic workplace safety and facility inspection covering general office conditions and potential hazards.
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GENERAL REFERRAL FORM
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A comprehensive medical referral form for scheduling various imaging procedures at Cedars-Sinai Medical Center.
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General Release And Medical Information Form
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A comprehensive form for youth program participants covering medical information, emergency contacts, and liability release for recreational activities.
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Glenville State University Reasonable Accommodation Medical Verification And Inquiry Form
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A form for employees to request medical accommodations at Glenville State University, involving medical verification and authorization for information release.
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General Test Request
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A comprehensive medical test request form used for submitting patient specimens and information to Mayo Clinic Laboratories for diagnostic testing.
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Partners HealthCare System Research Consent Form
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NatWest Mentor Services General Risk Assessment Form
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Risk assessment document for Covid-19 workplace safety at NatWest Mentor Services Main Building
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New ProgramInitiative Proposal Form
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A comprehensive form for proposing new academic programs or initiatives with detailed evaluation criteria and implementation planning.
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GENERAL CLAIM SUBMISSION FORM
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A comprehensive form for submitting insurance claims with sections for member information, coverage details, and claim specifics.
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General Test Requisition
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A comprehensive medical test requisition form for healthcare providers to submit specimens for laboratory testing, covering various health conditions and tests.
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University Health Report
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Comprehensive health form for Northeastern University students requiring vaccination documentation and personal health information
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Vaccine Administration Record (VAR)Informed Consent For Vaccination
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A comprehensive form for collecting patient information and consent for vaccination at Walgreens.
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Medical Release, Photo Release, Liability Waiver Form
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Comprehensive waiver for participants in a construction training program, covering medical risks, property damage, and legal liability.
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General Assessment Form
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A comprehensive form assessing patient's sleep, mental health, work performance, chronic condition management, and medication adherence.
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MEDICAL HISTORY AND RELEASE FORM
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Medical history and consent form for DeMolay participants under 21 years of age, including health history and liability release.
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Physician Referral Form
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A comprehensive medical referral form for routing patients to various medical specialties at Emory Healthcare.
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Patient Intake Form
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Comprehensive patient intake document for healthcare services, collecting personal, contact, and medical information with insurance and consent provisions.
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New Patient Intake Form
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Comprehensive medical intake form for new chiropractic patients, collecting personal information and detailed health history.
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Laboratory Specimen Collection Form
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A detailed form for collecting patient and specimen information for laboratory testing and analysis.
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Quartz Medicare Advantage (HMO) Quartz CashCard Reimbursement Form
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Form for Medicare members to request reimbursement for fitness memberships or medical transportation rides using their Quartz CashCard.
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Dental Claim Form
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A comprehensive form for submitting dental insurance claims, capturing patient, subscriber, and dental service details.
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Pre Participation Physical Evaluation History Form
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Official medical evaluation form for student-athletes participating in Georgia high school sports, detailing medical history and physical examination requirements.
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Michigan Gastrointestinal Illness Complaint Interview Form
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A comprehensive form for documenting and investigating gastrointestinal illness complaints, patient information, and medical details.
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LSU SVM Gift Contribution Form
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A form for making financial contributions to support various programs and funds at the LSU School of Veterinary Medicine.
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Gift Contribution Form
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A donation form for contributing to various funds within the Virginia Tech College of Veterinary Medicine
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Camper Medical Form
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Medical form for assessing a camper's health status, medical conditions, and fitness for camp participation.
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Health And Medical History Form
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A comprehensive medical history and health information form for American Heritage Girls members, valid for 12 months.
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Girl Scouts Health History And Medical Examination Form For Minors
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Comprehensive medical and health history form for Girl Scout participants to capture essential health information and emergency contact details.
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Health History And Medical Examination Form For Minors
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Comprehensive medical form for collecting health information and medical history for Girl Scouts participants under 18 years old.
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GITREP 4A Waiver Of SellerS Filing Requirement Of GITREP Forms And Payment For Corrected Deed With N
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A state form allowing property owners to record a corrective deed without additional tax filing requirements for typographical or clerical errors.
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City Of Ann Arbor Volunteer Release Waiver Of Liability
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Legal document outlining liability and risk assumptions for City of Ann Arbor volunteers, detailing participant responsibilities and legal protections.
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Gresham Japanese Garden Release, Waiver Of Liability And Indemnity Agreement
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Legal agreement for renting the Gresham Japanese Garden property, outlining risks and liability limitations for renters.
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Request For Benefits ClaimantS Report Of Loss
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A claim form for filing disability benefits for Glaziers, Architectural Metal and Glass Workers Local Union 1399 members.
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Short Term Disability Claim Form Statement Of Employee
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A comprehensive form for employees to file a short-term disability claim with detailed personal, employment, and medical information.
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Long Term Disability Claim Form PhysicianS Statement
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A comprehensive medical form for submitting a long-term disability insurance claim, requiring detailed patient and medical information.
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Global Mamas Health Emergency Contact Form
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A comprehensive medical and contact information form for Global Mamas organization, collecting personal details and health history.
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Global Studies Certificate Application Form
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An application form for students seeking to earn a Global Studies Certificate at their academic institution.
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GMAT Waiver Request Form
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A form detailing multiple pathways for qualifying for a GMAT test requirement waiver for graduate program admission.
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Greater Northwoods MLS Waiver Form
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A form for real estate professionals to request waivers for MLS listing requirements related to entry timing, photos, or listing status.
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Rental Agreement Form
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Rental form for airsoft equipment with terms of responsibility and rental details.
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Center For Endocrine Tumors And Disorders Patient Intake Form (Dr Goldfarb)
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Comprehensive medical intake form for patients with endocrine-related health concerns, collecting personal, medical, and medication history.
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Application For Good Cause Waiver
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A state application for individuals seeking a waiver for background screening findings related to employment eligibility.
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GENEVA ON THE LAKE POLICE DEPARTMENT BUSINESS CONTACT FORM
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A form for collecting contact and emergency details for local businesses by the Geneva-on-the-Lake Police Department.
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Gourmet Dining Supporting Small Businesses Waiver Form
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A document outlining procedures for external catering requests at Seton Hall University, managed by Gourmet Dining Services.
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Waiver Form And Multimedia Release Form
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Legal document for releasing liability and granting/denying media consent for park district program participation.
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GPLN Laboratory Submission Form
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Comprehensive form for submitting laboratory specimens related to poultry and avian health testing and research.
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Grade Appeal Form
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Form for students to request a review of their academic grade at Washington University School of Medicine.
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FAFSA Waiver Form
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A form allowing students to waive the requirement of completing the Free Application for Federal Student Aid (FAFSA) while acknowledging potential loss of financial aid eligibility.
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41 Graduate Program Declaration Form
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A form for students to declare or modify their 4+1 graduate program and undergraduate degree program at Ramapo College.
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Graduation Pathways Postsecondary Readiness Competency Waiver Form
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A form for students who did not complete postsecondary-readiness competencies or transferred schools during senior year to request a waiver for graduation requirements.
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General Outpatient Referral Form
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A medical referral form for patients seeking healthcare services at Grady Health System in Atlanta, Georgia.
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Grant Application Form
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A comprehensive grant application form for funding research and projects at the Mater Hospital Foundation in Dublin, Ireland.
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Grant Application Form
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Comprehensive form for submitting research grant proposals to the International Essential Tremor Foundation (IETF)
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Grateful Patient Contribution Form
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A form for patients to make tax-deductible contributions to support endodontic research, education, and awareness.
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Reimbursement Request
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Form for requesting reimbursement for emergency or unplanned overtime taxi rides under a Guaranteed Ride Home program.
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GRMC Foundation Contribution Form
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A tax-deductible donation form for supporting various fundraising categories at Gila Regional Medical Center Foundation.
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Pre Authorisation Form Group Care
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A medical insurance form for requesting cashless hospitalization, to be filled by the patient and treating doctor
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Group Short Term Disability Claim Form
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A comprehensive form for filing a short-term disability insurance claim with Dearborn National, capturing employee medical and income details.
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SCENE75 ENTERTAINMENT CENTER ALL VENUE ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
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Legal document releasing Scene75 Entertainment Center from liability for potential accidents or injuries during participation in venue activities.
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Georgia Regents University Volunteer Agreement Form
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A legal document outlining the terms and conditions for volunteers at Georgia Regents University, specifying responsibilities and limitations of volunteer service.
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Notice Of Emergency AndOr Hospitalization
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A court form used to report emergency situations or changes in status for an adult under guardianship in Nevada.
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Girl Scout Program Site Agreement (Form 700)
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An online form for Girl Scout program site authorization, with separate versions for standard troops and Juliette scouts.
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Graduate Student Request For Program Resignation And Transfer
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A form for graduate students to resign from one graduate program and transfer to a lesser degree program or certificate within the same discipline.
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GSS Waiver
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Legal document releasing UBC Graduate Students Society from liability for potential risks during an event or activity.
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Girl Scouts Health History And Medical Examination Form For Minors
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Comprehensive health history and medical examination form for Girl Scout participants to document medical information and insurance details.
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Shared Sick Leave Request Form
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A form that allows Georgia Tech employees to request donated sick leave when they have exhausted their own paid leave due to serious health conditions.
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Accident Claim Form
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Insurance claim form for documenting student accident details and health information authorization
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Guest Medical Information Form
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Confidential medical form for assessing guest fitness and suitability for an Antarctic expedition, collecting comprehensive health history.
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Guidance Obtaining Consent From Subjects With Limited English Proficiency
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Detailed guidance for obtaining informed consent from research subjects with limited English proficiency, covering different interpreter scenarios.
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Re Thinking Of Fashion In Research And Artist Collaborating Development For Urban Manufacturing Guid
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A collaborative research project inviting artists and designers to team up with scientists to reimagine fashion manufacturing processes through innovative technology and sustainable approaches.
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Guidelines For Acceptable Documentation
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Comprehensive guidelines explaining acceptable documentation for medical and personal circumstances affecting academic course completion.
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Guide To Completing The Patent Application Form (Form No.1)
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Comprehensive instructions for completing a patent application with details on patent types, fees, and required information for the Intellectual Property Office of Ireland.
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Accident Waiver And Release Of Liability
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Legal document waiving liability for participants in a university athletic event involving physical risks and potential injury.
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REIMBURSEMENT FORM
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Form for submitting optical services reimbursement to General Vision Services by members.
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Medical History Form
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A comprehensive form for collecting patient medical history, health details, and emergency contact information for dental service purposes.
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COVID 19 CVD Registry Powered By Get With The Guidelines Investigator Initiated Research Proposal Fo
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A form for researchers to submit investigator-initiated research proposals related to the COVID-19 Cardiovascular Disease Registry by the American Heart Association.
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Get With The Guidelines Quality Improvement Research Opportunity
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Request for research proposals focused on intracerebral hemorrhage (ICH) stroke using Get With The Guidelines data collection.
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Permission To Contact For Research
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A form allowing Gulf War veterans to authorize contact for potential research participation in a biorepository brain bank study.
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Gym Reimbursement Form
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A form to help employees get reimbursed for fitness facility memberships and track workout sessions.
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Reimbursement Request Form
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A form for members to request reimbursement for eligible healthcare services paid out-of-pocket.
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Influenza Sentinel Provider Report Form
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Comprehensive medical reporting form for tracking influenza cases, patient information, clinical data, and laboratory test results.
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PATIENT INTAKE FORM
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Comprehensive form for collecting patient personal, contact, insurance, and medical information for healthcare providers.
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Request For Hospital DischargeTransfer Approval Form (H 804)
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A medical form for documenting tuberculosis patient discharge, medication regimen, and transfer details for healthcare providers.
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2016 Haiti Mission Trip Payroll Deduction Form
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A form for employees of Morehouse School of Medicine to make a financial contribution to a Haiti Mission Trip through payroll deduction or direct payment.
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University Of Toronto Hand Fellowship Application Form
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Application form for medical professionals seeking a hand surgery fellowship at the University of Toronto.
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HAND TO HAND EMERGENCY CONTACT FORM
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A form for providing multiple emergency contact details for transportation service riders, with authorization for contact in case of emergencies.
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XAVIER HAP 2024 Personal Health History
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A comprehensive medical history form for students, to be completed by parents or guardians before submitting to a medical provider.
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Hardship Refund Request Form
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Policy detailing conditions and process for students to request tuition refunds due to exceptional medical or family circumstances.
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REQUEST FOR HARDSHIP WAIVER
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A form for individuals seeking an administrative hearing and fee waiver for parking tickets based on financial hardship
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Harn Museum Of Art Internship Application Form
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Application form for internship opportunities at the Samuel P. Harn Museum of Art at the University of Florida.
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Harn Museum Of Art Internship Application Form Fall Semester 2023
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Application form for students seeking internship opportunities at the Samuel P. Harn Museum of Art for Fall Semester 2023.
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Samuel P. Harn Museum Of Art Intern Application Packet
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Comprehensive internship application materials for students and professionals interested in museum careers at the Samuel P. Harn Museum of Art.
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Hawaii HIPAA Authorization For Release Of Information
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A form allowing patients to authorize the release of their personal health information to specified individuals or organizations.
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Registration Form
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Comprehensive registration form for healthcare services, collecting patient demographic, contact, insurance, and medical history information.
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HAZARD REPORT FORM
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A document for employees to report workplace safety hazards and for management to investigate and resolve potential risks.
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HAZARD REPORT FORM
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A comprehensive form for documenting workplace safety hazards, potential risks, and immediate actions taken to mitigate dangers.
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REQUEST FOR MEDICAL ELIGIBILITY DETERMINATION
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A form for assessing an individual's medical care needs and eligibility for healthcare services or facilities.
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Provider Enrollment Form
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Comprehensive form for healthcare providers to enroll and provide professional details for credentialing and practice information.
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Radiology Exam Order Form
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A comprehensive form for ordering radiology examinations, collecting patient, provider, and insurance information for medical imaging services.
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1500 Health Insurance Claim Form
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Standard medical claim form used for submitting healthcare insurance reimbursement requests.
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Patient Intake Form
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Comprehensive patient registration form collecting personal, demographic, and healthcare-related information.
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OHSU Referral Form
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A comprehensive medical referral form for patients being referred to various specialty departments at OHSU (Oregon Health & Science University).
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Health Care Provider Accommodation Assessment Form
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A form for employees to request reasonable workplace accommodations by obtaining medical documentation from their healthcare provider.
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Health Care Provider Examination Form
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A comprehensive healthcare provider form for documenting medical examinations, immunization history, and patient assessments.
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HCPCS Authorization Form
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Medical form used for requesting authorization for medical procedures or medications with detailed patient, physician, and treatment information.
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Form 4506 Health Care Practitioner Physical Assessment Form
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Medical assessment form for collecting a resident's comprehensive health history and current medical status for assisted living program admission
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Form 4506
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A detailed medical assessment form for evaluating a resident's health status and medical history for assisted living admission.
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Henderson County Parks Recreation Program Proposal Form
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A comprehensive form for instructors and contractors to propose recreational programs to Henderson County Parks and Recreation department.
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Weld HCP Referral Form
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A comprehensive referral form for healthcare coordination and client information collection in Weld County, Colorado.
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ADA Medical Questionnaire
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Medical questionnaire for employees requesting workplace accommodations under the Americans with Disabilities Act (ADA)
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CMS 1500 Claim Filing Instructions
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Detailed guidelines for completing the CMS-1500 healthcare claim form with specific instructions for each field.
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Mandatory Tuberculosis (TB) Risk Assessment Form
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A comprehensive medical form to assess tuberculosis risk factors and required testing for students, particularly those from high-risk regions or with specific exposure history.
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Role And Function Of The Joint Health Safety Environmental Committee Of The Mona Campus
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A comprehensive document outlining the establishment, role, and function of the Joint Health and Safety Environmental Committee at the University of the West Indies Mona Campus.
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Western Carolina University Base Camp Cullowhee Health And Medical Form
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A health screening form for participants in outdoor activities, collecting medical history and current health status details for safety purposes.
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Health And Temperament Agreement
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A legal agreement outlining owner responsibilities and liability waivers for dogs attending a dog daycare facility.
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SUNY State College Of Optometry Health Assessment
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Medical immunization and health screening form for SUNY State College of Optometry credentialing purposes.
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Health Assessment Form For Compliance With K.S.A. 72 5214
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A comprehensive health screening form for children entering school, requiring parental consent and medical provider certification.
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Software Solutions For The School Setting
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A software solution for tracking student and staff health information, designed to support schools during pandemic return-to-school protocols.
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Tips For Claim Submission
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Comprehensive guide for submitting healthcare and flexible spending account claims, detailing documentation requirements and eligible expenses.
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Tips For Claim Submission
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Comprehensive guide for submitting medical expense claims, including eligible expenses, documentation requirements, and over-the-counter medication rules.
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Expense Reimbursement Voucher For Healthcare Flexible Spending Account (Healthcare FSA)Health Reimbu
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A form for employees to request reimbursement for medical expenses through their flexible spending account or health reimbursement arrangement.
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Medical Inquiry Form Accommodation Request
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A medical form for healthcare providers to evaluate an employee's physical or mental impairments and potential workplace accommodations.
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Co PayDeductible Reimbursement Form
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Form for students to request reimbursement for medical co-pays and deductibles, with specific instructions and limitations.
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Health Examination Form (Form 003)
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Comprehensive health examination and immunization requirements form for nursing students entering a clinical program.
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Guam Travelers Health Declaration Form
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Health screening form for travelers entering Guam, tracking travel history, health symptoms, and potential exposure risks.
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HEALTH DECLARATION FORM
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A form for travelers to declare their COVID-19 health status and potential exposure prior to travel.
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Student Health Services Health Evaluation Form
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Medical form used by students to document health status, current conditions, and activity clearance for university health services.
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Required NYS School Health Examination Form
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Comprehensive health assessment form for students in New York State, documenting medical history and physical examination details.
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CHILDCARE GENERAL HEALTH EXAMINATION FORM
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A health examination form for children enrolling in early education programs to document their medical status and health conditions.
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Certificate Of Child Health Examination
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Official state document for recording child's health examination and immunization records.
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Health Extras Reimbursement Form
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Form for submitting healthcare service reimbursement claims through Independent Health's Health Extras program.
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Student Health Fee Reimbursement Form
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Form for Florida A&M University law students to request reimbursement for health service fees
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Health Fee Waiver Form
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A form allowing students to waive health fees based on specific exemption criteria under California Education Code Section 76355.
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HealthFlex Mandatory Premium And Coverage Waiver Form
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A form for employees to decline health insurance coverage and declare reasons for waiving enrollment in the HealthFlex plan.
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Health Form
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Medical health assessment form for participants in wilderness expeditions with Alaska Mountain Guides and Climbing School Inc.
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Girl Scouts Of West Central Florida Health Examination Form
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Comprehensive health form for documenting medical history and emergency contact information for Girl Scouts participants and volunteers.
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Physical Examination Form
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Medical form for documenting a child's physical health status and ability to participate in a child care program.
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Emergency And Health Forms Checklist
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Comprehensive checklist of required health and emergency forms for new and returning students to complete before the school year
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Health Records Form
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Comprehensive health documentation required for student enrollment at Bennett College, including immunization records and medical consent forms.
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Medical History Form
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Comprehensive medical history form for students collecting personal health information, medical conditions, and health maintenance details.
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Medical History Form
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Comprehensive medical history form capturing patient's health status, previous illnesses, and current medical conditions.
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Health History Physical Exam Form
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Confidential medical history form for Allied Health and Nursing students at Minnesota West Community and Technical College to document health status and medical background.
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MEDICAL HISTORY FORM
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Comprehensive medical history form for patient intake, collecting personal health information, medical conditions, and allergies.
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Health History Form
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Comprehensive health form for students to provide medical history, insurance, and emergency contact information to the university's student health center.
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Student Athlete Health History Questionnaire
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Comprehensive medical history questionnaire for student-athletes at State University of New York at Potsdam, focusing on orthopedic and head injury history.
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Male Health History Questionnaire
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Comprehensive medical questionnaire for collecting a male patient's health history, current concerns, and personal details.
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Health Incident Report Form
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A form for documenting health and safety incidents involving nursing students and faculty, to be completed within 24 hours of an occurrence.
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Health Information Form
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Detailed medical history and personal health form for participants, collecting comprehensive health information and emergency contact details.
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Retiree Health Cancellation Form
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A form for retirees to cancel their health coverage and dependent coverage through Blue Cross Blue Shield.
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School Health Inspection Form
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Official form for documenting health and safety inspections of school facilities in New Hampshire, ensuring compliance with state education standards.
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School Health Inspection Form
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Official form for documenting health and safety inspections of school facilities by local health officials in New Hampshire.
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Health Insurance New EnrollmentWaiver Form
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A form for AmeriCorps members to enroll in or waive health insurance coverage during their program participation.
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Health Insurance Waiver Form
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A form for Genesee Community College employees to waive their group health insurance plan and provide alternative coverage evidence.
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Maryland State Department Of Education Health Inventory
PDF template
A comprehensive health documentation form for children enrolling in Maryland child care facilities, requiring physical examination, immunization records, and blood-lead testing information.
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HEALTH INVENTORY FORM
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A comprehensive medical history form for collecting student health information, including past diseases, treatments, and current medical status.
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Medical Claim Form
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A comprehensive form for submitting medical insurance claims, capturing patient, subscriber, and medical service details.
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Authorization For Use Or Disclosure Of Protected Health Information
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A confidential form authorizing the disclosure of protected health information by The Episcopal Church Medical Trust
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HealthMedication Authorization Form
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Form for authorizing medication administration for participants in M-NCPPC park and recreation programs, including prescription and non-prescription medications.
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HEALTHPHYSICAL EXAMINATION FORM
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Medical examination form for students enrolling in various healthcare and child care educational programs to assess physical fitness and health status.
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Lindgren Child Care Center Health Procedures
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Comprehensive guidelines for handwashing and managing child health procedures in a child care center, focusing on preventing illness spread.
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Health Professions Personal Medical History Form
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Medical documentation form for health professions students to submit immunization and health screening records for clinical experiences.
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HEALTH PROFESSIONS STUDENT HEALTH FORM
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Medical documentation form for students in nursing, pharmacy, physician assistant, and dietetic internship programs, requiring immunization history and verification.
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ETA FORM 653 Job Corps Health Questionnaire
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A health assessment form for Job Corps applicants to provide medical information and authorize basic healthcare services
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Health Risk Assessment Form
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A comprehensive form that evaluates an individual's physical health, personal safety, fitness, nutrition, work environment, and social-emotional well-being.
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Health And Safety Student Waiver Form Part A
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COVID-19 safety waiver for students participating in boot camp activities at the Bahamas Technical and Vocational Institute.
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Health Savings Account (HSA) Contribution Form
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A form for depositing funds into a Health Savings Account with instructions for contribution types and participant authorization.
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Physical Examination Form
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A comprehensive medical examination form required for admission to health science programs at Laredo College.
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Health Services Student Medical Form
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Comprehensive medical form for students enrolling in various healthcare-related programs and continuing education classes at Catawba Valley Community College.
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MCPS Form SRS 6 Student Record Card 6
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A comprehensive health form for students entering Maryland public schools, requiring medical examination and immunization documentation.
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Meningitis And Hepatitis B Immunization Health History Form
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Comprehensive form detailing immunization requirements for students, including MMR, Varicella, and Tuberculosis skin test documentation guidelines.
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School Health Services Health Survey Form
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A comprehensive health information form for students entering school, collecting medical history, contact information, and health service needs.
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Vital Strategies Healthy Food Policy Fellowship Application Form
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Application form for a fellowship program focused on contributing to healthier food environments in selected countries.
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DCH 1315 Health Risk Assessment
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A confidential form for collecting personal health information to help individuals improve their health and healthcare coverage through the Healthy Michigan Plan.
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Heartland Anglers Membership Form
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Membership registration form for Heartland Anglers fishing tournament participants with liability release and contact information collection.
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STUDENT RECORD CARD SR 6 (Local)
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A mandatory health form for students entering Maryland public schools, documenting physical examinations and immunization requirements.
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Medical Form
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Medical history and immunization form for students, requiring detailed health information and parental consent.
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Medical Form
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Comprehensive medical history and immunization form for students, requiring detailed health information to be completed by parents/guardians and physicians.
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DR. E. BRUCE HENDRICK ONTARIO SCHOLARSHIP PROGRAM 2023 MEDICAL ASSESSMENT FORM
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A medical assessment form for students with spina bifida or hydrocephalus applying for the Dr. E. Bruce Hendrick Ontario Scholarship Program.
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Hepatitis B Vaccine Waiver
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A document allowing students to opt out of receiving the Hepatitis B vaccine while acknowledging the risks and benefits of immunization.
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Hepatitis B Vaccination Waiver Form
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Form for students to decline Hepatitis B vaccination while acknowledging potential health risks from occupational exposure.
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NIDDK Hepatology Fellowship Application Form
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Application form for individuals seeking a hepatology fellowship at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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THREE WAY CONFIDENTIALITY AGREEMENT
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A multi-party confidentiality agreement for potential research and business collaboration involving exchanging sensitive information.
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Release And Waiver Of Liability
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Legal document releasing Habitat for Humanity from liability for volunteers participating in construction and related activities
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PATIENT FRIENDLY BILLING PATIENT GLOSSARY OF BILLING TERMS
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A comprehensive guide to commonly used financial terms in healthcare billing, designed to improve patient understanding of medical financial communications.
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NYCHHC HIPAA Authorization To Disclose Health Information
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A form authorizing the release of personal medical and health information with specific privacy protections and consent requirements.
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Hickory Hill Member Family Emergency Contact Form
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A form for collecting emergency contact and medical authorization details for club members and their families.
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Texas Health And Human Services Acronym Guide
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A comprehensive list of acronyms used by Texas Health and Human Services covering various healthcare and administrative terms.
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NCIEC Healthcare Interpreting Fellowship Application Form
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Application form for healthcare interpreters seeking a professional fellowship program in medical interpreting across multiple US locations.
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Patient Intake Form
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Comprehensive medical questionnaire collecting patient personal, insurance, and health history information for medical providers.
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FDNY HIPAA AUTHORIZATION TO DISCLOSE HEALTH INFORMATION
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Form authorizing the release of personal health information with specific consent parameters and privacy protections.
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HIPAA Compliance Patient Consent Form
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A form detailing patient consent for healthcare information usage, disclosure, and privacy practices under HIPAA regulations.
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Authorization For Release Of Health Information Pursuant To HIPAA
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Official form allowing patient authorization for release of sensitive medical information in compliance with HIPAA regulations.
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HIPAA Acknowledgement And Medical Information Release Form
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A form for patients to authorize release of medical information and provide contact preferences for communication.
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Privacy Complaint Form
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A form for patients to submit written complaints regarding privacy and confidentiality of protected health information.
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HIPAA Privacy Authorization Form
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A form authorizing the use and disclosure of protected health information (PHI) in compliance with HIPAA regulations.
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Friends Of Hawaii State Art Museum Membership
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A membership form for supporting and contributing to the Hawaii State Art Museum's local arts community.
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Histology Service Request Form
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A form for requesting histology laboratory services with sample submission details and contact information.
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HSS Histopathology Service New Project Request
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A form for researchers to request histopathological services at the HSS Research Institute for investigating autoimmune, inflammatory, and orthopedic diseases.
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Medical History Form
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Comprehensive medical form for capturing patient health history, symptoms, and medical conditions across various body systems.
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HIV Case Report Form
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A comprehensive medical form for documenting HIV patient demographics, testing history, and risk factors.
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Pediatric Provider Referral Form
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A form for healthcare providers to refer pediatric patients for additional services or evaluations.
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Hmsa Travel Assistance Request Form
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A form for requesting travel-related medical assistance or coverage through HMSA health plan
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Harvard Outing Club Medical Form
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A comprehensive medical form for Outing Club members to provide emergency medical information and disclose health conditions that might impact trip participation.
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HOD COMMITTEE VOLUNTEER FORM
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A form for volunteering to serve on various committees for the House of Delegates meeting, including reference committees and other organizational groups.
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Holiday Magic 2016 Competition Guidelines
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A competition inviting participants to create imaginative gingerbread houses for display at the Springfield Science Museum during the holiday season.
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Hooper DSC Referral Form
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A medical referral form for patient intake and scheduling at a healthcare facility with specific requirements and patient information collection.
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Hematology And Oncology Physician Coverage (HO PC) Service
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A document outlining objectives and expectations for physician coverage in Hematology and Oncology during nights and weekends.
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Horse Emergency Contact Form
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A form for collecting emergency contact details for a horse, including owner, veterinarian, and farrier information.
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Hospital Admission And Discharge Records
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A document discussing a new standardized form for recording psychiatric hospital patient admissions and discharges, with concerns about patient confidentiality.
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Hospital Discharge Form
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A form to document patient details and discharge readiness, including medical conditions and follow-up care requirements.
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Hospitalization Pre Authorization Form
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A comprehensive form for patients and healthcare providers to request pre-authorization for hospital admission and medical treatment from Jubilee Health Insurance.
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STD 236 Hotel Motel Transient Occupancy Tax Waiver
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A form for California state employees to certify tax-exempt hotel stays related to official state business.
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How To Choose The Correct Proof Of Insurance Form
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A decision tree for University of Illinois staff, faculty, students, and medical professionals to determine the appropriate proof of insurance form to submit.
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Medical Release Form
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Step-by-step guide for completing an online medical release form for Forest Home organization through CircuiTree registration account.
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HIGH PLAINS MUSIC CAMP MEDICAL FORM
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Comprehensive medical form for participants of High Plains Music Camp, collecting personal, medical, and emergency contact information.
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Health Professions Recruitment And Exposure Program 2022 Parental Consent Form
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Consent form for minor students participating in a medical education recruitment and exposure program at Weill Cornell Medical College.
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PARENTAL CONSENT FORM
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Consent form for minors to participate in the Health Professions Recruitment and Exposure Program at Weill Cornell Medical College.
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Entity Professional Liability Insurance Application
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An insurance application form for healthcare entities seeking professional liability coverage for their practice and healthcare professionals.
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Haverhill Public Schools Emergency Notification
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A form for employees to provide emergency contact and notification information for the Haverhill Public School System.
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