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Federal Paid Sick Leave Expanded Family And Medical Leave Request Form
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Medical screening form for assessing a diver's physical and mental fitness to participate in diving activities.
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Comprehensive medical form for patient demographics, insurance information, and diagnostic specimen collection details.
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Official form for requesting refunds for the American Thyroid Association's 89th Annual Meeting registrations and associated events.
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Comprehensive medical screening form for assessing an individual's fitness for scuba diving activities by documenting medical history and potential health risks.
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A medical referral form for patients seeking genetic counseling and potential genetic testing services.
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Comprehensive medical history questionnaire to collect patient health information and potential medical conditions.
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Comprehensive health examination form for students in New York State schools, covering medical history and current health status.
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Comprehensive medical history form capturing patient health details, previous treatments, and current medical conditions.
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Medical release and consent form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
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A medical consent form for waxing services that collects client health information and potential skin sensitivity risks.
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Form for requesting tuition waivers for retired employees, dependents, and special arrangements at DePaul University.
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Form for employees to purchase FitBit activity trackers through corporate wellness program with payroll deduction options.
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Comprehensive medical form for collecting new patient information, including personal details, contact information, medical history, and healthcare connections.
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New Patient Intake Form
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Comprehensive medical intake form for capturing patient personal, contact, and medical history information for dental practice.
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Medical release and contact information form for minors participating in the Summit Music Festival seminar program and concert series.
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North Dakota ICWA Inquiry Form
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2020 States 4 H OB Medical Form (Non Japan)
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Medical evaluation form for 4-H international exchange program delegates to assess health and fitness for cross-cultural exchange.
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Medical release and consent form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
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USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
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Medical release and emergency contact form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
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Shenandoah Outdoor Adventure Recreation Health And Medical Form
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Comprehensive health form for participants in Shenandoah University outdoor and adventure recreation programs, collecting medical history and emergency contact information.
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Form for employees to request paid leave due to COVID-19 quarantine or isolation orders in New York State.
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A comprehensive medical form for evaluating a patient's need and suitability for a wheelchair, including medical and functional assessments.
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A form for employees to request time off from work, specifying type of leave and dates.
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Incident Report
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A form used to document workplace incidents, accidents, illnesses, or exposures for the University of New Mexico-Taos.
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Official form for obtaining identification cards to access CBP security areas for employees involved in importing and handling merchandise.
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Annual Pre Participation Physical Evaluation
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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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POGS Sickness Benefit Application Form
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AU Direct Deposit Authorization 2019
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Form for submitting warranty claims for prosthetic products and detailing product and patient information.
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A refund request form for council activities during the 2021 calendar year, with special COVID-19 related refund provisions.
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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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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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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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Resica Falls Summer Camp Refund Requests
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Policy detailing refund conditions and payment schedules for Resica Falls Summer Camp, including COVID-19 and non-COVID refund guidelines.
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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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2021 Year Round Camping Refund Request Form
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Guidelines for managing COVID-19 exposure and quarantine procedures for PreK-12 educational settings based on vaccination status and symptoms.
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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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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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Travel Form Instructions
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Comprehensive instructions for district employees on completing travel forms, obtaining approvals, and reimbursement procedures for business travel.
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Manchester Employees Contributory Retirement System Additional Contribution Calculation Request
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POGS MAP Sickness Benefit Application Form
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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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A document allowing employees to authorize direct deposit of wages and provide banking details for payroll processing.
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Notice Of Privacy PracticeClinics
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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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A screening questionnaire to assess potential COVID-19 exposure and symptoms for convention attendees.
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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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Annual membership registration form for the Isett Community Pool with various membership options and family details.
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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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Resica Falls Summer Camp Refund Requests
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Comprehensive refund policy for Resica Falls Summer Camp, covering deposit requirements, COVID-19 related refunds, and individual cancellation scenarios.
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Employee Timesheet
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A timesheet document for tracking employee work hours and certifying time worked for staffing and payroll purposes.
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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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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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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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Manchester Employees Contributory Retirement System Additional Contribution Calculation Request
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A form allowing employees to request calculation of additional retirement contributions with specific authorization and salary assumptions.
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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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Flexible Spending Account (FSA) Enrollment Form
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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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Flexible Spending Account Agreement Form
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A form for employees to elect and set up Flexible Spending Accounts for healthcare and dependent care expenses.
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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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SupervisorS Incident Investigation Form
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PATIENT INTAKE FORM
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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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New Hire Active Employee Enrollment Form
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Nomination Form Leonard W. Sandridge Outstanding Contribution Award
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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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Resiliency Loan Fund Application
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A loan application for small businesses and nonprofits impacted by COVID-19, offering up to $150,000 at 0% interest.
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Department Of Juvenile Justice Attendance And Leave Form
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Official form for tracking employee work hours, leave, and compensation for Department of Juvenile Justice personnel
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Pre Authorization Request Form
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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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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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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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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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18th Annual Combat Fishing Tournament Participation Approval Form
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Official form for military personnel to obtain approval for participating in an annual fishing tournament
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DIRECT DEPOSIT CANCELLATION FORM
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Form for canceling direct deposit of retirement benefit payments for Hanford Employee Welfare Trust retirees.
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Dual Membership Form Leonhard Recreation Center Martens Center
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Form for registering a dual membership at Leonhard and Martens Recreation Centers with options for individual and family memberships.
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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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FULL TIME DOMESTIC PARTNERSHIP AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR HEALTH INSURANCE EFFECTIVE Y
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Authorization form for employees to select health insurance coverage options and allow payroll deductions for Essex County health insurance plans
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2024 Guardian Dental Cancellation Form
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A form to request cancellation of Guardian Dental insurance coverage by an employee.
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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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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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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 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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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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Lions Park Aquatic Center Membership Application
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Application for seasonal pool membership at Boonville Lions Park Aquatic Center with pricing and membership details.
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Disability Insurance Claim Packet Instructions
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Instructions for filing a disability insurance claim with Standard Insurance Company, detailing the application process and required documentation.
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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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Conference RequestTravel Reimbursement Form
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Form for employees to request and document travel expenses and reimbursement for conference or training activities.
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2024 Vanderbilt Payroll Deduction Form
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A form allowing Vanderbilt University employees to purchase season tickets via payroll deduction with specific eligibility rules and conditions.
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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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Combined Giving, Contribution Election Agreement
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A form for employees to authorize charitable contributions through payroll deductions for selected agencies.
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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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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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Employee HSA Payroll Deduction Form
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A form for employees to authorize payroll deductions for their Health Savings Account contributions with annual contribution limit details.
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Benefits Administration Letter 21 303
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Guidelines for federal agencies seeking reimbursement for emergency paid leave under the American Rescue Plan Act of 2021.
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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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COVID 19 Updates W 2 And Related Programs
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Temporary policy changes for W-2 programs in response to COVID-19 pandemic, including verification and meeting requirements.
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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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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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Progressive Discipline Action Form
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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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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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LEAVE REQUEST FORM
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A form for employees to request various types of leave from work, including documentation of absence type, duration, and required approvals.
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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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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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Use Of PCC Van (OP P 262)
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Establishes criteria and process for reservation and use of PCC vans by authorized employees for official college activities.
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Corporate Personal Pension Employee Application Form
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An employee application form for a corporate personal pension plan with Professional Provident Society Investments.
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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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University COVID Travel Policy
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Policy requiring pre-authorization for all Wake Forest-sponsored travel during the COVID-19 pandemic to protect campus community health and university financial interests.
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COVID 19 VACCINATION CONSENT FORM
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Consent form for receiving COVID-19 vaccines at Public Health Seattle & King County Vaccination Sites.
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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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Sick Leave Pool Contribution Form
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A form allowing employees to voluntarily donate sick leave hours to a shared organizational sick leave pool.
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303 Employee Compensation And Leave Time
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A policy outlining paid time off procedures, compensation, and leave time guidelines for full-time salaried employees at St. George Academy.
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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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UC ANR Leave Request Form
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Form for employees to request and document a leave of absence, including details of leave type, dates, and signatures.
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IRIS Travel Policy And Procedures
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Comprehensive guidelines and procedures for travel by IRIS employees, covering authorization, costs, transportation, lodging, and reimbursement.
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UCPATH DIRECT RETRO REQUEST
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A form for processing salary expense transfers for UC employees, replacing the previous UCCE Salary Expense Transfer Request form.
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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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Election For Online W 2 Delivery Form
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Form for Texas State University employees to consent to or withdraw from electronic W-2 delivery via online portal
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Administrative Procedure 323 SEPARATION
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Procedures for nonacademic, administrative, and academic employees terminating employment with the University, including handling of benefits and exit process.
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Employee Performance Review Form Appendix 324A
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A comprehensive form for evaluating employee performance, goals, and professional development
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Pension Application Form
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Comprehensive application form for pension insurance covering employer and employee details for individual or group policies.
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Performance Review
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Comprehensive guide detailing the systematic process for conducting employee performance reviews within the Unified Government organization.
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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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3.4.1p. Employee Access To Facilities
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Procedure detailing key fob and access control for employees at Ogeechee Technical College, including how access is granted and managed.
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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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Form 3503 FR.03 Termination Checklist
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A comprehensive checklist for HR specialists and departments to follow when processing an employee's termination, covering administrative and equipment-related tasks.
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PPP Loan Application Form 3508S
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Cerritos College FORMS
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Comprehensive collection of human resources forms for Cerritos College employees covering various administrative and personnel processes.
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UNC Hurricane Matthew Special Leave Request Form
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Form for UNC employees to request paid leave due to substantial damage from Hurricane Matthew
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TOWN OF MILLIS EMERGENCY CONTACT FORM
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A form for employees to provide personal contact information and emergency contact details for workplace safety purposes.
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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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3 Month Probationary Review
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Policy and procedure for conducting a 3-month performance review for new employees during their 6-month probationary period.
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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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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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Emergency Paid Sick Leave Request Form Under The Families First Coronavirus Response Act (FFCRA)
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Form for employees to request paid sick leave for childcare needs during COVID-19 school and daycare closures.
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Procedure 410 19 Employee Volunteer And Education Leave
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A policy providing full-time employees with 8 hours of annual leave for volunteer and educational activities in the community.
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Interim Guidance For Quarantine Restrictions On Travelers Arriving In New York State
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Updated COVID-19 travel guidance for domestic and international travelers entering New York State, outlining quarantine and testing requirements.
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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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Medical Service Request Form
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Employee Benefit Plan Enrollment
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Montgomery County Public Schools form for new employees and those with qualifying life events to enroll in benefit plans
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Direct Deposit
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Procedure for processing employee direct deposit forms, including enrollment, changes, and verification steps.
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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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Personnel Maintenance Request Form
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A form used by East Lake Tarpon Special Fire Control District to manage employee system access, including new user setup, security changes, and employee deactivation.
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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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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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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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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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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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Staff Movement Register
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A record-keeping tool for tracking staff movements, arrivals, departures, and visits within an organization
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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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Authorization Form For RIPTA Wave Pass Payroll Deduction
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A form allowing state employees to authorize payroll deductions for purchasing Rhode Island Public Transit Authority (RIPTA) commuter passes.
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Performance Expectations Feedback Form
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A formal document for documenting performance deficiencies and required corrective actions for employees.
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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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Employee Emergency Contact Form
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A document for collecting employee emergency contact information and personal details for workplace safety and communication purposes.
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LEAVE REQUEST FORM
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A form for employees to request and track various types of leave including annual, sick, personal, and unpaid leave.
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DULA Leave Request Form
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A form for employees to request various types of leave including sick, vacation, and unpaid leave at Dongguk University Los Angeles.
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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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Leave Program Procedures
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Detailed procedures for vacation leave accrual and usage for employees at Owens Community College.
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Employee Estimated Expense Approval Form
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A form for employees to request approval and reimbursement for estimated travel and business expenses.
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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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Career Personnel Performance Review
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A comprehensive performance review document for assessing an employee's job performance, knowledge, quality, and quantity of work.
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EMPLOYEE LEAVE REQUEST FORM
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Official state form for employees to request various types of leave from work, including vacation, sick leave, and other time-off categories.
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Employee Time Off Request Form
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A form for employees to request time off for various reasons, subject to employer approval.
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Shared Leave Request Form
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A form for state employees to request shared leave due to serious medical conditions or family illness.
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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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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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TIME OFF REQUEST FORM
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Detailed guidelines for employees requesting time off and supervisors documenting vacation time
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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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INFORMATIONAL CIRCULAR NO. 21 P 001
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Guidance for state agencies on tax withholding requirements for employees teleworking due to COVID-19 pandemic.
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Procedure 4.4.3p. (III.M.I.) Employee Complaint Resolution
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A formal process for resolving work-related employee complaints within the Technical College System of Georgia, ensuring fair treatment and open communication.
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Student Health Information Form
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Comprehensive health information form for collecting student medical and contact details at a university
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Auxiliary COVID 19 High Risk Assessment Form
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A form for Coast Guard Auxiliarists to assess their suitability for duty during the COVID-19 pandemic based on CDC high-risk categories.
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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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Incident Investigation Form
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A comprehensive form for documenting workplace incidents, injuries, and required follow-up actions.
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Employee Name Change Form
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A form for employees to update their name in university payroll and HR systems with required documentation.
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Vehicle Parking Registration
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Form for employees to register their vehicles for parking at UWSA (University of Wisconsin System Administration) location.
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Summary Plan Description Bargained Cash Balanced Program 2 Of The ATT Pension Benefit Plan
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A comprehensive guide to benefits for employees under the Bargained Cash Balance Program #2, detailing pension plan provisions and eligibility.
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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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GROUP PLANS ENROLLMENT FORM
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Comprehensive form for employees to select and enroll in group insurance and benefit plans covering life, disability, medical, and supplemental insurance options.
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82.1 Time Off Requests And Call Offs
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Guidelines for police department employees to request time off and report call offs through PlanIT Police system
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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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Administrative Policy And Procedures Manual 901 REIMBURSABLE BUSINESS RELATED EXPENSES
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Policy outlining the Judicial Branch's guidelines for employee reimbursement of job-related expenses and travel.
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Procedure 902 Leave And Absence Policies
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Guidelines for leave accrual, use, and donation for sworn police department members, including annual leave policies and absence regulations.
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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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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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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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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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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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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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Application Form Child Benefit
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Official form for applying for child benefit in the Caribbean Netherlands for children aged 0-17 years.
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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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COVID 19 TEMPORARY CATERING AUTHORIZATION APPLICATION
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Application for temporary catering authorization for alcohol service during COVID-19 pandemic for California licensees.
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Payroll Deduction Guide
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A comprehensive guide explaining how employees can contribute to ABLE United accounts through payroll deductions and the responsibilities of employees, employers, and the Plan.
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Alternate Benefits Program Mandatory Contributions 401(A) Voluntary 403(B) Loan Authorizations
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Procedure for employees to request and process loans through investment providers using specific authorization steps.
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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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CONFIDENTIAL ADOPTION INQUIRY
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A detailed confidential form for prospective adoptive parents to apply to Abrazo's adoption programs with personal and demographic information.
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Form F Absence Report Form
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A form for students to report anticipated or unanticipated absences during a Physician Assistant Studies program.
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Direct Deposit Form For NYS Employees
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Form for New York State employees to set up, modify, or cancel direct deposit bank account information for payroll.
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Academic Affairs Personnel LEAVE REQUEST FORM
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A comprehensive form for university employees to request various types of leave with multiple approval levels.
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Affordable Care Act (ACA) Health Insurance Payment AUTHORIZATION FOR VOLUNTARY PAYROLL DEDUCTION
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Authorization form for employees to voluntarily have health insurance premiums deducted from their paycheck under the Affordable Care Act.
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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
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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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NNSA Facility Access Identification Requirements
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Detailed document outlining acceptable forms of personal identification for accessing NNSA facilities for U.S. citizens.
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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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Key Electronic Access Request Form
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A form for requesting building and room access, keys, and electronic entry devices for employees and workers at an organization.
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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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Report Of Accident Incident
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A form for documenting workplace accidents or incidents involving university personnel, students, or workers.
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Accident Injury Report
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Comprehensive document for reporting and documenting workplace accidents, injuries, and worker's compensation claims.
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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
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Comprehensive form for documenting workplace accidents, injuries, and related incident details with personal and organizational information.
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Waubun Ogema White Earth AccidentIncident Report Form
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A form used to document workplace accidents or incidents, capturing details about the event, potential prevention, and property damage.
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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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AccidentIncident Report Form
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A comprehensive form for documenting workplace accidents or incidents at East Stroudsburg University by employees, students, and visitors.
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City Of Kirkland Accident Report Form
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A comprehensive form for reporting workplace accidents, injuries, and potential liability claims for City of Kirkland employees.
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AccidentIncident Reporting Form
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Comprehensive guidelines for reporting accidents, incidents, and hazards on university premises, detailing reporting processes and medical response protocols.
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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
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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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Payroll Cancellation Form ACC PYB001
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A government form for employees to cancel an existing payroll deduction for the Government of Guam.
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Direct Deposit Form ACC PYD001
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Form for employees to set up, change, or cancel direct deposit for payroll with the Government of Guam.
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Multi Location Travel Expense Reimbursement Request
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A comprehensive form for employees and students to request reimbursement for travel-related expenses at North Dakota State University.
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MEDICAL RELEASE FORM
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A form granting permission for medical treatment of a student during official academy participation with emergency contact and medical information.
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Retirement Contribution Form
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A form for employers to set up electronic fund transfer (EFT) contributions to employee retirement accounts, specifically 403(b) and other retirement plans.
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Student Inquiry Form
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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
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A form authorizing automatic payment deductions for medical consultations and services from a bank account.
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CLAIM FORM
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A comprehensive insurance claim form for collecting detailed policyholder and incident information for processing an insurance claim.
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Patient Medical History Form
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Comprehensive medical history form for collecting patient health information, symptoms, and medical conditions.
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Medical Information
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A comprehensive medical form collecting personal health details for emergency preparedness at an event or track setting.
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Patient Intake Form Holistic Health Assessment
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Confidential questionnaire for determining patient treatment plan and collecting comprehensive medical and personal information.
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Patient Intake Form
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Comprehensive form for collecting patient personal, contact, medical, and insurance information for chiropractic services.
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New Patient Intake Form
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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
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Form for requesting authorization for hospital admissions and stay extensions for Blue Cross and Blue Care Network commercial plans
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Employee Application For Reimbursement Of Expenses Incurred Upon Sale Or Purchase (Or Both) Of Resid
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Government form for employees to claim reimbursement for relocation-related real estate expenses when changing official work station.
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Documentary Materials RemovalNon Removal Certification And Non Disclosure Agreement
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A certification document outlining rules for removing or retaining documentary materials when leaving USDA employment.
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AD 3121 Employee Citizenship Form
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A form used by the U.S. Department of Agriculture to collect employee citizenship and birth information.
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Americans With Disabilities Act Accommodation Request Assessment Form
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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
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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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DOH 3608 Uninsured Care Programs Medical Eligibility Form
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A medical form used to determine patient eligibility for HIV-related care programs in New York State
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ADA Job Accommodation Request And Medical Inquiry Form
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A confidential form to help determine reasonable workplace accommodations for employees with disabilities under ADA guidelines.
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Sick Leave And Short Term Disability Policy
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Policy outlining sick leave provisions and short-term disability benefits for Champlain College employees, defining eligibility and guidelines for income replacement.
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Diagnostic Imaging Referral Form
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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
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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
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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
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A comprehensive health examination form for students in New York State, documenting medical history and current health status
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AdditionalOutside Employment During Leave Request Form
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Form for faculty to request additional or outside employment during an approved leave period
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Additional Shifts Approval Form
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Form for documenting and approving additional paid shifts for medical residents and fellows beyond their normal program requirements.
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NAMEADDRESSEMERGENCY CONTACT FORM
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A form for new hires and existing employees to update personal contact and emergency information
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Address Changes
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Guidelines for updating employee and student addresses in the University's Directory System for payroll, retirement, and insurance correspondence.
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Addressing Vaccine Inequity During The COVID 19 Pandemic The TRIPS Intellectual Property Waiver Prop
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Academic article examining global vaccine inequity, critiquing intellectual property law and proposing a TRIPS waiver to address production and distribution barriers.
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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
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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
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A form used by healthcare providers to request adjustments or void payments for medical services.
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Daemen College Employee Evaluation Instruction
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A comprehensive performance evaluation form for administrative personnel at Daemen College, detailing assessment criteria and development goals.
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Discrimination Or Harassment Incident Report
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A formal document for reporting discrimination or harassment incidents within Prince George's County Public Schools by employees or volunteers.
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C911CD Time Off Request Form
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A standardized form for employees to request time off from work, specifying leave type and duration.
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ACADEMIC AND CLASSIFIED ADMINISTRATORS VOLUNTARY SICK LEAVE BANK CONTRIBUTION FORM NEW EMPLOYEE
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A voluntary form for academic and classified administrators to contribute sick leave days to a shared sick leave bank for potential future use by administrators.
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Admission Agreement And Health Assessment
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Comprehensive form for child enrollment, medical history, emergency contacts, and health assessment for childcare or educational settings.
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Adobe Generative AI Additional Terms
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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)
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A consent form for parents/guardians to authorize vaccination of adolescents for Tdap/Td, HPV, and Meningococcal ACWY vaccines.
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ADOM Travel Form
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Travel form documenting COVID-19 travel requirements for priests, employees, and students within the Archdiocese
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Information Exchange Authorization
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A form allowing authorized individuals to request and exchange adoption-related information through the Illinois Department of Public Health's Vital Records Division.
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Adoption Assistance Reimbursement Form
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Form for employees to request reimbursement for qualified adoption expenses through the university's adoption assistance program.
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Adoption Benefit Financial Reimbursement Form
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A form for employees to request financial reimbursement for eligible adoption-related expenses up to $5,000 per child.
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Hospice Volunteer Application Form
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A comprehensive application form for individuals interested in becoming hospice volunteers, collecting personal, contact, and background information.
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ALINE Card Enrollment Form
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Enrollment form for employees to set up direct deposit of wages to an ALINE Card issued by ADP and MB Financial Bank
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Aging Disability Resource Center Food Resources COVID 19 Supplement
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A comprehensive guide to food resources and services for older adults and persons with disabilities across Hawaii counties during the COVID-19 pandemic.
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MINOR PARTICIPANT EMERGENCY CONTACT AND MEDICAL RELEASE FORM
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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
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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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FMLA ADULT CHILD DISABILITY MEDICAL INQUIRY FORM
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Medical documentation form to verify disability status of an adult child for FMLA leave purposes in New Mexico.
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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
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A comprehensive form for collecting patient personal and demographic information for healthcare services.
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Adult HIV Confidential Case Report Form
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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 Medical Release Form
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Provider Appeal Request
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Patient Intake Form
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Blue Cross Medical Travel Benefit Claim
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Alternative Work Considerations Request Form
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Medical Examination Report For Bus Transit System Driver
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AMERICAN CLUB PRE EMPLOYMENT MEDICAL EXAMINATION FORM2019
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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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AMI Insurance Application
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UA Performance Evaluation Comprehensive Form
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Annual Health Evaluation Form
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Question Set G
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Survey for current and former Financial Conduct Authority employees seeking input and evidence on organizational matters.
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Auxiliary COVID 19 High Risk Assessment Form
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Member Claim Form
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Medical Insurance Claim Form
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Medical Claim Form
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Medical Claim Form
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Medical Claim Form
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Medical Claim Form
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AO Alliance (AOA) ORP Fellowship Application Form
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AO Alliance (AOA) Surgeon Fellowship Application Form
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COVID 19 Assumption Of The Risk Forms
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PARTICIPANT MEDICAL HISTORY FORM
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Employee Expense Direct Deposit Form
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Appendix 5 Medical Release Form
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Appendix T San Diego Police Department Crime Laboratory Feedback Form
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Request For Funds (CARES RR Grant)
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FHNO Institutional Fellowship Application Form
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Form for employees to request paid sick leave related to COVID-19 under federal and New York state regulations.
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Virtual board meeting minutes detailing COVID-19 remote participation procedures for the Cambridge Redevelopment Authority.
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Documentation And Approval Of Spousal And Family Travel Form
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OCCUPATIONAL MEDICAL SURVEILLANCE PROGRAM PHYSICAL EXAMINATION FORM
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Payroll Donation Form
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Remdesivir Prescribing DeclarationStreamlined IPU Application Form
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Alexandria Soccer Association Medical Release Form
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Central Registry Referral Form
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Referral Form
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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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Employee Handbook
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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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Associate Leave Request Form
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Health Assessment Form Supervisor Guidance
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COVID 19 Assumption Of The Risk Forms
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Asthma Assessment Form For School
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Athlete Emergency Contact Form
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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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ParentGuardian Communication Athletic Screening
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Guidelines for student athletes participating in strength and conditioning sessions during COVID-19 period, including health screening and safety requirements.
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Athletic Travel Form
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MedicalForensic Examination Form
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Administrative Regulation 95.91 Employee Rewards And Recognition Program ATTACHMENT 2 Employee Of T
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Waiver Service Request Form (DP 1022)
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Bishop Canevin Attendance Notice
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Official school document for recording student absences, tardiness, early dismissals, and medical appointments.
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MILES COLLEGE ATTENDANCE FORM
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A monthly form for tracking employee work hours and attendance at Miles College, to be submitted to Human Resources by the 25th of each month.
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Miles College Attendance Form
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A monthly form for tracking employee work hours and attendance at Miles College with spaces for detailed time tracking and signatures.
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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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Consent To Use Sound And Image Recordings That May Contain Identifying Information For Education
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IHS Diabetes Care And Outcomes Audit, 2024
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AUGUSTA UNIVERSITY FFCRA LEAVE REQUEST FORM
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Form for employees to request leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
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Patient Intake Form
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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
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Form for comprehensive employee medical examinations, drug testing, and workplace health screening documentation.
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Authorization And Driving History Form
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A form documenting employee driving authorization, vehicle operation details, and liability requirements for state vehicle use.
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Authorization For Direct Deposit Via ACH
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Authorization Form For Payroll Check(S) To Be Mailed
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A form allowing employees of Bronx Community College to authorize mailing of their payroll checks to a specified address.
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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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Authorization To Receive Compensatory TimeOvertime
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A university form for employees to request and obtain approval for overtime work or compensatory time
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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
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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
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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
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Detailed form for documenting vehicle accident details and patient information for insurance or medical purposes.
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Auxiliary COVID 19 High Risk Assessment Form
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A form to assess Coast Guard Auxiliary personnel's medical suitability for duty during the COVID-19 pandemic based on CDC high-risk categories.
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Auxiliary COVID 19 High Risk Assessment Form
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Form to assess Coast Guard Auxiliary personnel's medical risk during the COVID-19 pandemic for duty assignment purposes.
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Nomination Form
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A form for nominating an individual for recognition within an organization, capturing details about the nominee and nominator.
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Healthy Families Workshop Elluarrluteng Ilakutellriit Registration Form
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Registration form for the Association of Village Council Presidents' Healthy Families Workshop focusing on cultural wellness and community support.
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Avera EConsult Assessment Form
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A comprehensive medical assessment form for telemedicine patient consultations, capturing patient information and physical examination details.
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Animal Workers Medical Surveillance Consent For Medical ScreeningEvaluation
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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
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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
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Comprehensive medical history and emergency contact form for children attending various sports camps in Maine.
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Patient Authorization Form
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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
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A form used by UnitedHealthcare Community Plan members to request reimbursement for medical services, co-payments, coinsurance, and deductibles.
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Request For Leave
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Los Angeles Community Colleges Personnel Guide B382 Reduced Workload Leave
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Guidance for certificated faculty to reduce workload while maintaining full-time retirement benefits under specific conditions.
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My Choice Wisconsin BadgerCare Plus Authorization Form
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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
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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
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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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Banner System Access Request Form
PDF template
A form for employees or individuals requesting new or modified access to the Banner system with specific access level details.
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BANNER UNIX ACCOUNT APPLICATION FOR EMPLOYEES
PDF template
Form for employees to request access to various Banner modules and Unix accounts at Texas Southern University
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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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Waiver And Release Of Liability
PDF template
Legal document waiving liability for potential COVID-19 exposure at Bartle Scout Reservation by Heart of America Council, Boy Scouts of America.
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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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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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Entering Time For Astrix Benefit Hours An EmployeeS Quick Reference Guide
PDF template
A guide for employees on how to enter benefit hours including PTO, holiday, and sick leave using the online timesheet application.
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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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FamilyAdult Only Membership Application
PDF template
Application form for families and adults to join community programs and services offered by Boston Centers for Youth & Families.
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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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COVID 19 BUSINESS SUSTAINABILITY CONTINUITY FUNDING PROGRAMME APPLICATION FORM
PDF template
Application form for small and medium businesses seeking financial support during the COVID-19 pandemic through direct micro loans and grants.
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COVID 19 BUSINESS SUSTAINABILITY CONTINUITY FUNDING PROGRAMME APPLICATION FORM
PDF template
Application form for small and medium businesses seeking financial support during the COVID-19 pandemic through micro loans and relief grants.
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Self Service Employee Business Expenses
PDF template
A comprehensive guide for employees to submit and track business expense reimbursements through a self-service system, including instructions and IRS compliance details.
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Direct Deposit Form
PDF template
Form for employees to set up direct deposit for benefits reimbursements with bank account details and authorization.
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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 Billing Form
PDF template
A form for employees to elect benefits continuation options during FMLA or general leave of absence
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Dental Insurance Plan
PDF template
Insurance plan detailing dental coverage eligibility for employees and their dependents at the University of Nebraska.
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Benefits Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and optional insurance benefits
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Benefit Time Policy Changes
PDF template
Policy modification for Chicago employees regarding paid sick leave, paid leave, and PTO accrual in compliance with new Chicago ordinance.
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BEREAVEMENT LEAVE APPROVAL REQUEST
PDF template
A form for employees to request bereavement leave following the death of an immediate family member with specific guidelines on leave duration and eligibility.
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Bereavement Leave Request Form
PDF template
A form for employees to request paid leave following the death of an immediate family member, with specific provisions for leave duration based on funeral location.
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Bereavement Leave Request Form
PDF template
A form for employees to request paid leave following the death of an immediate family member at Northwest University.
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Bereavement Leave Request Form
PDF template
A form for employees to request time off following the death of a family member or household member, with provisions for up to ten working days of leave.
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Bereavement Leave Request Form
PDF template
Form for employees to request time off for funeral or bereavement leave under Oregon Family Leave Act (OFLA)
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Butterfly Club Opportunity Drawing Ticket Deduction Form
PDF template
Employee authorization form for purchasing Butterfly Club event tickets via payroll deduction
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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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Discharge Form
PDF template
A form used to document and track patient discharge details for behavioral health clinical services.
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Direct Deposit Enrollment For Stipends From The Ben Hudnall Memorial Trust (BHMT) Education Program
PDF template
A form for Kaiser Permanente employees to enroll, change, or terminate direct deposit of stipend payments through the Ben Hudnall Memorial Trust education program.
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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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Update Personal Information
PDF template
A form for employees to update their personal contact details and emergency contact information.
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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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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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Birthday Party Rental Contract
PDF template
Contract for renting birthday party facilities at Eastside Family Place, including fees, membership requirements, and party details.
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Snow College Business Cards Order Form
PDF template
A form for Snow College employees to order personalized business cards with various printing options.
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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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Employee Time Off Request Form
PDF template
A standardized form for employees to request various types of leave and obtain manager approval.
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Health Savings Account (HSA) Payroll Deduction Form
PDF template
Form for employees to authorize automatic payroll deductions into their health savings account (HSA)
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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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Performance Review Form
PDF template
A comprehensive document for assessing employee job performance, setting future goals, and providing overall performance ratings.
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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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LABCORP SEND OFF LABS SERVICE ORDER FORM
PDF template
Comprehensive medical service and drug screening form for workplace health assessments, covering various physical examinations, drug tests, and COVID-19 screenings.
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Bond Agreement Between Employee And Employer
PDF template
A legal document outlining the terms of employment, including potential financial obligations and restrictions for employees.
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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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Shipment Booking Form For 2019 NCoV
PDF template
A form for booking courier shipments of biological specimens related to 2019-nCoV (COVID-19) research samples.
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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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Policy On Boot Camps
PDF template
COVID-19 attendance tracking form for recording participants in face-to-face instructional sessions at BTVI
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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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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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Bravo Award Nomination Form
PDF template
A multi-section form for nominating employees for performance awards with various approval levels and award amounts.
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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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Bright Directions Payroll Deduction Form
PDF template
Form for initiating, changing, or stopping payroll deductions for Bright Directions College Savings Program accounts.
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Brightline Employee Special Offers
PDF template
Transportation pass details for employees with special pricing between Miami, Fort Lauderdale, and West Palm Beach stations.
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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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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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Graduate Assitant Time Off Request Form
PDF template
A form for graduate assistants at Bilkent University to request time off from their academic duties and responsibilities.
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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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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 Guidelines For Community Use
PDF template
Guidelines for community groups using the UUCS building, including COVID-19 safety protocols and rental procedures.
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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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BursarS Office Form 15A Application For Staff Fee Remission When Auditing A Course
PDF template
A form for qualified university staff to apply for fee-free course auditing without receiving academic credit.
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Bursar Payroll Deduction Authorization
PDF template
A form allowing employees to authorize or cancel payroll deductions for their bursar account at Xavier University.
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Business Card Order Form
PDF template
A form for employees to request and order personalized business cards through an online ordering system.
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Payroll Time And Attendance Form Preparation
PDF template
Procedure manual detailing the process for completing payroll time and attendance forms at County College of Morris.
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Employee Requisition Form
PDF template
Formal document for requesting and approving new or replacement employee positions within the university's organizational structure.
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City Of Spokane Business Resilience Loan Fund By Craft3
PDF template
Loan program for qualifying Spokane businesses to fund working capital during the COVID-19 pandemic, offering loans from $10,000 to $50,000.
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Business Travel Leave Request Form
PDF template
A form for employees to request and document business travel, including trip details, expenses, and required approvals.
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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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Payroll Check Direct Deposit Authorization
PDF template
A form for employees to authorize electronic transfer of payroll funds to one or multiple bank accounts.
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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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CAH Termination Policy
PDF template
Comprehensive policy detailing exit procedures for employees leaving the University of Central Florida's College of Arts and Humanities.
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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 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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Payroll Deduction Authorization
PDF template
Authorization form for North Carolina A&T State University employees to deduct recreation center fees from payroll
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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 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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Revised CA Presentation Checklist Writable
PDF template
A form for submitting proposals and presentations to the College Affairs committee with details about policy updates.
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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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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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Staff Council CARE Award Nomination Form
PDF template
A form to nominate University of Texas at Dallas staff members for recognition of outstanding performance and service.
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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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CARES ACT EMERGENCY CARES ACT GRANT REQUEST FORM
PDF template
Application for students seeking financial assistance for COVID-19 related online education expenses through CARES Act funds at Dakota County Technical College.
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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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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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Leave Donation Request City Of Fond Du Lac
PDF template
A confidential form allowing employees to request donated sick, vacation, or floating holiday hours from colleagues during a medical hardship.
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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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Catholic Charities Contribution Form
PDF template
A payroll form allowing University of Portland employees to initiate or terminate recurring charitable contributions to Catholic Charities.
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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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SAP Payroll Time Management Time Entry
PDF template
Documentation for recording employee timesheet data in SAP time management system for University of Mississippi departments.
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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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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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Modified Family Assessment Form (MFAF)
PDF template
A comprehensive assessment tool for evaluating family interactions and relationships in therapeutic settings.
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BADGE REQUIREMENTS LACS CARD REQUIREMENTS
PDF template
Comprehensive guide outlining acceptable forms of identification for citizenship verification and badge issuance.
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CEAT Travel Form Exemption Request For Essential Research And Extension During COVID 19 Travel Sus
PDF template
Form for requesting travel exemption for essential research and extension activities during COVID-19 travel restrictions
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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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CCC Time Off Request Form
PDF template
A form for employees to request time off, including vacation, sick leave, or day-for-day leave for exempt employees.
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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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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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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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Cultural Competency Professional Development (CCPD) Credit By Attendance Form
PDF template
A form for employees to document and request credit for professional development activities related to cultural competency and equity training.
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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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LEAVE REQUEST CERTIFIED
PDF template
A comprehensive form for employees to request various types of leave, including sick leave, personal leave, and FMLA/OFLA.
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LEAVE REQUEST CLASSIFIED
PDF template
A comprehensive form for employees to request various types of leave, including sick leave, personal leave, and special absences.
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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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Safety Committee Policy
PDF template
Policy establishing the formation, membership, and purpose of a safety committee for the Deschutes County Adult Jail to promote workplace safety and health.
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Safety Committee Policy
PDF template
Policy establishing a workplace safety committee for the Deschutes County Adult Jail to promote workplace safety and health through cooperative efforts.
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Declaration Under Penalty Of Perjury For The Centers For Disease Control And PreventionS Temporary H
PDF template
A legal declaration allowing individuals to certify eligibility for eviction protection during the COVID-19 pandemic based on specific income and financial hardship criteria.
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CDC Temporary Halt In Evictions Declaration
PDF template
A legal document allowing tenants to declare their inability to pay rent due to COVID-19 economic impacts and prevent eviction.
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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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2020 Camp COVID Update
PDF template
Mid-America Council's guidelines for operating summer camps during the COVID-19 pandemic, detailing safety measures and potential changes.
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Cell Phone Allowance Cancellation Form
PDF template
A form to cancel cell phone reimbursement for employees of the University of Utah's Payroll Department.
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CEM Employee Travel Authorization Form
PDF template
A form for obtaining departmental approval and documenting travel expenses for employee business trips.
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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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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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Classified Employee Of The Month Nomination Form
PDF template
A form for nominating exceptional classified employees at the College of Southern Nevada for monthly recognition and awards.
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College Of Southern Nevada Classified Employee Of The Month Nomination Form
PDF template
A form to recognize and nominate exceptional classified employees at the College of Southern Nevada for monthly recognition.
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Certificated Catastrophic Leave Application
PDF template
A form for employees to request catastrophic leave days through bank donation, direct donation, or additional sick leave for serious medical conditions or family care.
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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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Oregon Sick Time Request Form
PDF template
A form for employees to request and document use of Oregon sick time hours for payroll processing.
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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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Child Information Form
PDF template
A comprehensive form collecting detailed information about a child and their caregiver for potential social services or child welfare referral.
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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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EMPLOYEE PAID TIME OFF REQUEST FORM
PDF template
A form for CFS SDS employees to request and track paid time-off hours, requiring employee and HR signatures.
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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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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 Direct Deposit
PDF template
Instructions for changing direct deposit payment method by completing and uploading a form to the Benefits Portal.
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STANDARD CHANGE FORM
PDF template
A form used for updating employee payroll information, deductions, and status for existing employees or new hires.
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GROUP POLICY CHANGE FORM
PDF template
A form for employees to request changes to their group insurance policy details and dependent status.
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Address Change Request
PDF template
Form for employees to update their contact information in the company's HR system (PeopleSoft)
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Change Of Address Form
PDF template
Official form for employees to update personal contact information and address details with the City University of New York (CUNY) Office of Human Resources.
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Employee Change Of Address Form
PDF template
A form for employees to update their personal contact and address information with their employer.
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CHANGE OF ADDRESS FORM
PDF template
A form for employees to update their mailing address with the Office of Human Resources.
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Employee Change Of Address Form
PDF template
A form for Puyallup Tribe of Indians employees to update their personal contact and address information with Human Resources.
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Change Of Name And Address Policy
PDF template
Policy outlining the process for employees to update their personal information with the university's Human Resources department within 30 days of changes.
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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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Research (Visa) Application Checklist
PDF template
Comprehensive checklist for research visa applications to Papua New Guinea, including required documents and COVID-19 related forms.
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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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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 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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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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Choice PCA Paid Time Off Request Form
PDF template
A form for Choice PCA employees to request paid time-off from their client, requiring approval and submission to payroll.
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COVID 19 FDA Authorized Over The Counter Test Member Reimbursement Form
PDF template
Form for members to request reimbursement for authorized FDA over-the-counter COVID-19 tests, with specific guidelines and limitations.
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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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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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Enrollment Change Form (Consolidated)
PDF template
A comprehensive form for employees to enroll or change health insurance and related benefits with multiple coverage options.
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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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COVID 19 ERA Program Application
PDF template
A temporary program providing emergency financial assistance for rent, utilities, and housing expenses for low-income Coquille Tribal members and Indian families impacted by the COVID-19 pandemic.
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TIME AND LEAVE REQUEST FORM
PDF template
A form for interns to request annual leave time within the CUNY IT Specialists Internship Program, with specific guidelines for submission and usage.
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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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COVID 19 Travel Form 9
PDF template
A form required for travelers to Saint Paul Island during the COVID-19 pandemic, detailing travel details and exceptions for entry.
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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 reasons.
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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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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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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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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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Conference Attendance Report Form
PDF template
Form for classified employees to document conference attendance, learnings, and key insights from professional development events.
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Leave Request Form (5 Days)
PDF template
A form for employees to request extended leave of 5 or more days, to be submitted to Human Resources with supporting documentation.
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LOWER COLUMBIA COLLEGE CLASSIFIED PPE FOOTWEAR PURCHASE FORM
PDF template
A form for employees to request reimbursement or purchase of personal protective equipment (PPE) footwear up to $200 every two years.
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Payroll Deduction Form
PDF template
Form for employees to set up or modify payroll deductions for the Chaffey College Auxiliary Classified Senate account.
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Contribution Form Catastrophic Sick Leave Bank
PDF template
A form for classified employees to voluntarily contribute sick leave days to a shared catastrophic leave bank for extreme circumstances.
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Classified TransferPromotion Request Form
PDF template
A form for employees of Cutler-Orosi Joint Unified School District to request an internal job transfer or promotion.
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CCLLA Classified Leave Application
PDF template
A comprehensive form for employees to request various types of leave, including vacation, sick, FMLA, and flex time adjustments.
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Classified Employee Appraisal Process
PDF template
A comprehensive workflow for conducting performance evaluations for Administrative & Professional and Classified Employees at UTRGV.
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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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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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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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2024 2025 Nomination Of Classified Professional
PDF template
Nomination form for classified professionals to participate in a leadership development program within the Chabot - Las Positas Community College District.
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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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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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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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ChildrenS Museum Shoals Membership Form
PDF template
Membership form for joining the Children's Museum Shoals with options for family, single parent, and grandparent memberships.
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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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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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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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Referral Form
PDF template
A form for healthcare providers to request patient referrals and provide medical background information.
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Employee Flexible Spending Account (FSA) Enrollment Form
PDF template
Form for employees to enroll in Flexible Spending Account (FSA) options for healthcare and dependent care expenses.
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Collection Process Protocol
PDF template
A protocol detailing modifications to civil debt collection processes during the COVID-19 pandemic, addressing garnishments, bank account attachments, and case scheduling.
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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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Employee Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including annual, sick, FMLA, and other leave types, requiring supervisor and HR approval.
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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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Information Disclosure Consent Form For UN COVID 19 Medical Evacuation (MEDEVAC) Services
PDF template
Consent form for medical information disclosure and liability release for UN COVID-19 medical evacuation services.
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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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Commercial Vehicles COVID 19 Deliveries Vehicle Title AndOr Registration Application Checklist
PDF template
Application for vehicle title and registration for commercial vehicles delivering relief during the Coronavirus national emergency.
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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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School District Of Philadelphia Community Training Reimbursement Form
PDF template
Form for employees to request reimbursement for educational training expenses and transportation costs within the School District of Philadelphia.
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Complaint Documentation Form
PDF template
A comprehensive form for documenting and investigating employee complaints, including initial reporting, meeting details, and investigation procedures.
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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 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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COQUILLE SCHOOL DIST. COMPENSATION PRE AUTHORIZATION
PDF template
A form for employees to request and receive pre-authorization for extra work hours and compensation
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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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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 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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ConferencePersonalSickVacation Leave Request Form
PDF template
A form for staff members to request various types of leave, including conference, personal, sick, and vacation time, with documentation requirements.
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ConferenceTravel Pre Approval Form
PDF template
A form for employees to request pre-approval for conference or travel expenses with detailed cost estimation and reimbursement guidelines.
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Confidential Employee Evaluation Process
PDF template
A comprehensive document outlining the performance evaluation procedures and process for employees at Victor Valley Community College District.
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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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CONFIDENTIALSUPERVISORY EMPLOYEES ABSENCE REPORT FORM
PDF template
A form for reporting employee absences, specifically detailing bereavement leave policies for supervisory employees.
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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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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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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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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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Electronic Consent For W 2 Tax Form And 1095S Health Insurance Offer And Coverage Statement
PDF template
Step-by-step guide for employees to provide electronic consent for receiving W-2 and 1095-C tax and health insurance forms online
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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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Doa Ana County Head Start Contact Form
PDF template
A contact form for documenting child and family information at a Head Start center with multiple follow-up categories.
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Contact Information And Medical Form
PDF template
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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Determining EmployeeContractor Status
PDF template
A document used to assess and determine the worker classification status for tax and employment purposes.
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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
PDF template
A form for tracking and documenting annual physical inventory of controlled substances as required by state and federal regulations.
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ING Premier Disability Cancellation Form
PDF template
A form for employees to cancel their ING Premier Short Term Disability insurance policy and associated payroll premium deduction.
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Time Off Request Form
PDF template
A form for employees to request and track time off hours across two weeks.
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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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Corrective And Disciplinary Action Form
PDF template
A formal document used to record workplace misconduct, performance issues, and potential disciplinary actions for employees.
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Employee Counseling Action Form
PDF template
A formal document for documenting employee performance issues, counseling actions, and potential consequences.
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RPCI.GEN.LAB.PATH.Frm.0023.00 Delivery Form
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A form for tracking and delivering medical laboratory samples between locations.
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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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COVID 19 Policy Procedure
PDF template
Comprehensive policy and procedure guidelines for managing COVID-19 positive residents and staff in healthcare settings.
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Things To Think About From A Benefits Perspective During The COVID 19 Pandemic
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A document outlining COVID-19 test reimbursement, free test kit options, and virtual care services for MUSC Health Plan members.
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COVID 19 Vaccination Record And Consent Form
PDF template
A form for documenting COVID-19 vaccination consent, administration details, and patient information for care home residents.
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Consent To Treat During COVID 19 Pandemic
PDF template
A consent form for patients receiving elective healthcare during the COVID-19 pandemic, acknowledging potential risks and preventive measures.
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COVID 19 Close Contact Interview Form
PDF template
A form used by the Florida Department of Health to interview and track individuals who have been potentially exposed to COVID-19.
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Coronavirus (COVID 19) Death Report Form
PDF template
Confidential form for reporting details of a COVID-19 related death, including patient demographic and clinical information.
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COVID 19 Domestic Travel Form
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A form for documenting and obtaining approval for domestic travel during the COVID-19 pandemic for Texas A&M AgriLife Research personnel.
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Mennonite Village Covid 19 Earned Leave Request Form
PDF template
A form for employees to request sick or personal days related to COVID-19 circumstances
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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
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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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FFCRA 2021 PAID LEAVE REQUEST FORM
PDF template
Form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) provisions
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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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Historic Royal Palaces General Risk Assessment Form
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A comprehensive risk assessment document addressing COVID-19 hazards and controls for Historic Royal Palaces work settings.
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COVID 19 Case Interview Form
PDF template
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
PDF template
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
PDF template
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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COVID 19 Outbreak Report Form
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A form for reporting probable COVID-19 cases and outbreaks in facilities and businesses, detailing clinical criteria and outbreak resolution definitions.
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FFCRA 2021 Paid Leave Request Form
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) framework
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Leave Request Form CA COVID 19 Leave Request Form
PDF template
Form for employees to request COVID-19 supplemental paid sick leave under Senate Bill 95 and the American Rescue Plan Act.
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REQUEST FOR COVID 19 LEAVE
PDF template
A form for Miami-Dade County employees to request paid sick leave related to COVID-19 reasons and circumstances.
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APPENDIX 5 PARENTAL CONSENT FORM
PDF template
A consent form for parents/guardians of junior/youth athletes to allow COVID-19 testing and data processing during an event.
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COVID 19 Participant Code Of Conduct And Risk Assessment Form
PDF template
Comprehensive guidelines for Special Olympics participants during the COVID-19 pandemic, outlining safety protocols and personal responsibilities.
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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 Participant Code Of Conduct And Risk Assessment Form
PDF template
Guidelines for participant safety and risk mitigation during Special Olympics activities during the COVID-19 pandemic.
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Schnucks COVID 19 Pay Plan
PDF template
Policy detailing pay continuance and time off benefits for Schnucks employees during 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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Covid 19 Pre Survey Form
PDF template
A pre-survey form for water system representatives to complete before an on-site survey during the Covid-19 pandemic, outlining safety protocols and requirements.
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COVID 19 Prevention Program (CPP)
PDF template
A comprehensive workplace safety program designed to prevent COVID-19 transmission among employees at Mt. San Antonio College in compliance with California occupational safety regulations.
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COVID 19 Paid Time Off For Individual Providers
PDF template
A program providing paid time off for Individual Providers in Illinois who are unable to work due to COVID-19 related circumstances.
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COVID 19 Relief Fund Contribution Form
PDF template
A contribution form for donating to Broward Health Foundation's COVID-19 Relief Fund to support healthcare workers and patient care.
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2019 Novel Coronavirus Case Report Form
PDF template
A comprehensive form for reporting COVID-19 cases to local health departments, capturing patient details and investigation information.
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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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IOSH Risk Assessment Form
PDF template
Risk assessment document for reducing COVID-19 transmission risks in workplace settings, focusing on shift changes and communal areas.
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Site Assessment Form
PDF template
A form for assessing COVID-19 safety precautions for student placements at external sites during the pandemic.
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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 Work From Home Authorization Form
PDF template
A form for employees to request and document work from home arrangements during the COVID-19 pandemic.
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CLIENT ACKNOWLEDGMENT FORM AGREEMENT CARES ACT EMPLOYEE RETENTION CREDIT
PDF template
Form for businesses to acknowledge eligibility and terms for Employee Retention Credit under the CARES Act during COVID-19 pandemic.
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Families First Coronavirus Response Act Emergency Paid Sick Leave Request Form
PDF template
A form for Logan City School District employees to request emergency paid sick leave under the Families First Coronavirus Response Act for COVID-19 related reasons.
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WESTFIELD PUBLIC SCHOOLS COVID 19 SICK LEAVE FORM
PDF template
Form for employees to request COVID-19 related sick leave, detailing qualifying reasons for leave under Massachusetts emergency regulations.
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COVID 19 SICK LEAVE FORM
PDF template
A form for employees to request COVID-19 related sick leave under Massachusetts temporary emergency regulations.
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DNR Enhanced Safety Protocols For Volunteers During COVID 19
PDF template
Guidelines for DNR volunteers to safely perform activities during the COVID-19 pandemic, with specific protocols based on county reopening phases.
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Patient Summary For Person With Developmental Disability
PDF template
Emergency medical form for individuals with developmental disabilities showing potential COVID-19 symptoms, including personal information, symptoms, risk factors, and medical history.
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Request For COVID 19 Employer Paid Leave Of Absence
PDF template
A form for employees to request paid leave related to COVID-19 circumstances including personal illness, vaccination, or childcare needs.
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COVID 19 Leave Request
PDF template
A form for employees to request leave due to COVID-19 infection, requiring documentation of a positive test and HR verification.
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UCF COVID Medical Release Instructions
PDF template
Guidelines for University of Central Florida employees and students regarding COVID-19 medical clearance and campus return protocols.
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COVID 19 Order Form
PDF template
Medical form for collecting patient information and COVID-19 specimen details for testing purposes.
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COVID Vaccine Patient Intake Form 2021
PDF template
Patient intake form for COVID-19 vaccination at Stauffer's Drug Store and Stauffer's LTC Pharmacy, collecting patient information and insurance details.
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COVID 19 Self Assessment Form Template
PDF template
A self-assessment form for state Ombudsman representatives to complete before visiting long-term care facilities during the COVID-19 pandemic.
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COVID 19 Release Of Liability Form
PDF template
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 Relief Support Application
PDF template
Application for COVID-19 relief support programs for registered Mtis NationSaskatchewan citizens and those with pending citizenship applications.
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Risk Assessment Form
PDF template
Risk assessment for cash transactions during COVID-19 pandemic, outlining hazards and control measures for staff and customers.
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Risk Assessment Form
PDF template
Risk assessment for receiving and handling deliveries during the COVID-19 pandemic to minimize potential virus transmission.
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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
PDF template
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
PDF template
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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KSU Campus Employee Registration Form
PDF template
Registration form for KSU campus employees to request permission to attend a professional education course with supervisory approval.
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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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Direct Deposit Request
PDF template
A form for employees to set up or cancel direct deposit banking information for payroll purposes.
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Funeral Leave Request
PDF template
A supplemental form for employees requesting leave to attend a family member's funeral, requiring documentation of the deceased's details.
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Juror Attendance Form
PDF template
Form for LANL employees to document and verify jury duty service for payroll purposes.
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Payroll Deduction Authorization Zia Credit Union
PDF template
Authorization form for employees to set up, change, or cancel payroll deductions to Zia Credit Union
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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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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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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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Crisis Leave Request Form
PDF template
A form for employees to request leave from the Crisis Leave Pool for personal or family health conditions or extraordinary personal crises.
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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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Crisis Leave Request Form
PDF template
A form for employees to request time off through a crisis leave pool for personal or family medical emergencies.
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Request For The Crisis Leave Program
PDF template
A form for employees to request crisis leave for personal or family serious health conditions under FMLA guidelines.
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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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Criteria For Furman Sponsored Off Campus, In Person Experiences During The COVID 19 Pandemic
PDF template
Guidelines for Furman University students participating in off-campus, in-person experiences during the COVID-19 pandemic, outlining safety requirements and protocols.
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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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CROSS ACT 2020 TIMESHEET
PDF template
A document for tracking employee work hours, time worked, and payment details for record-keeping and payroll purposes.
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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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CSUCI ALTERNATE WORK SCHEDULE PROGRAM APPROVAL FORM
PDF template
A form documenting employee request and approval for a 9/80 alternative work schedule at California State University Channel Islands.
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List Of Items Returned By The Employee
PDF template
A comprehensive form for documenting the return of university-owned equipment and assets by an employee upon separation or leaving the institution.
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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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SEPARATING ATTENDANCE FORM
PDF template
A form used by California State University, San Bernardino for tracking employee separation details and final attendance records.
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Grace Period Extension Agreement
PDF template
An agreement allowing insurance customers additional time to pay premiums during the COVID-19 pandemic without plan termination.
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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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Commitment To Excellence Award 2024 Nomination Form
PDF template
Award nomination form recognizing outstanding university staff and administrators who demonstrate exceptional commitment and performance.
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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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Employee Performance Evaluation Form
PDF template
Annual performance evaluation documenting goals, objectives, and performance dimensions for an Internal Medicine Account Assistant
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Clerical And Technical Performance Feedback
PDF template
A comprehensive form for assessing employee performance across multiple dimensions including communication, customer service, dependability, and technical skills.
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Connecticut Paid Leave Application Document Checklist
PDF template
A comprehensive guide for applying to Connecticut's Paid Leave program, detailing qualifying circumstances and required documentation for income-replacement benefits.
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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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Estate Inventory Worksheet
PDF template
A comprehensive document for collecting personal and asset information to assist with estate planning and legal preparation.
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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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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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Custodial Department Time Off Request Form
PDF template
A form for Gundersen Facilities Services employees to request time off for various leave types.
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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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Patient Registration Form
PDF template
A comprehensive medical intake form for collecting patient personal and insurance details for healthcare services.
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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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2011 OPSEU Time Off Request Form
PDF template
A comprehensive form for employees to request vacation time during different periods, including prime time summer, non-prime time, and holiday periods.
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RCUH Form D 3
PDF template
A comprehensive form documenting employee separation from the Research Corporation of the University of Hawai'i, covering voluntary resignation and involuntary termination details.
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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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Salary AssignmentCancellation (Form D 60)
PDF template
Detailed instructions for completing a salary assignment or cancellation form for University of Hawaii employees
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Families First Coronavirus Response Act Leave Request Form
PDF template
Form for Kansas state employees to request leave under FFCRA for COVID-19 related reasons
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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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Order Approving Settlement
PDF template
Court order approving settlement between plaintiffs John Cale Brown and Darlena Brown and defendants Fort Benning Family Communities and Michaels Management Services, Inc.
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MEDICAL INQUIRY FORM IN RESPONSE TO AN ACCOMMODATION REQUEST
PDF template
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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HR Records Administration Data Verification Request Form
PDF template
A form for collecting comprehensive personal and organizational information for HR record-keeping at the University of Alabama at Birmingham.
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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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DCBS Superhero Award Nomination Form
PDF template
A form to nominate DCBS employees for recognition based on exemplary professional qualities and performance.
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OVERTIME REQUEST FORM
PDF template
A form for employees to request and receive supervisor approval for overtime work hours.
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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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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 1617 Department Of Defense Transportation Agreement
PDF template
Official Department of Defense form establishing government service requirements and transportation allowances for civilian employees transferring outside the continental United States.
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DD FORM 1618, DEC 2023
PDF template
A Department of Defense form establishing government time in service requirements for travel and transportation allowances for civilian employees transferring within CONUS.
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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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DIRECT DEPOSIT CANCELLATION REQUEST FORM
PDF template
Form for employees to cancel their existing direct deposit banking information for payroll purposes at UNC Greensboro.
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Direct Deposit Cancellation Form
PDF template
A form used by employees to cancel their existing direct deposit payroll arrangements with Johns Hopkins institutions.
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EmployeeS Withholding Allowance Certificate (DE 4)
PDF template
A form for employees to specify their state income tax withholding allowances and exemption status for California tax purposes.
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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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Employee Incident Investigation Form
PDF template
A formal documentation of an incident involving workplace interactions and potential inappropriate conduct between an employee and her supervisor.
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Death Benefit Application Form
PDF template
A form for Fiji Bank & Finance Sector Employees Union members to apply for death benefits for themselves or eligible family members.
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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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PARKING DECAL REFUND REQUEST
PDF template
A form for employees or students to request a refund for parking decals at Southern Illinois University Carbondale under specific conditions.
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Declaration Under Penalty Of Perjury For CDC Temporary Halt In Evictions
PDF template
A legal declaration for tenants seeking protection from eviction during the COVID-19 pandemic based on financial hardship.
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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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Declaration Form
PDF template
A sworn declaration form for scholarship applicants to provide family and educational details
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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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Decrease Election Form For Supplemental Life Insurance
PDF template
A form for active state employees to reduce their supplemental life insurance coverage in prescribed increments.
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Payroll Deduction Cancellation Form
PDF template
A form allowing employees to cancel specific payroll deductions at Western Michigan University.
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COMPENSATION AND BENEFITS TRAVEL REIMBURSEMENT
PDF template
Procedures and guidelines for travel expense reimbursement for employees, volunteers, and other individuals traveling on College business.
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Designated Eligible Individual (DEI) Enrollment Form 2024
PDF template
Form for Michigan Tech employees to enroll a non-spouse individual for health coverage under specific eligibility criteria.
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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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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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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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COBRA Dental Insurance EnrollmentWaiver Form
PDF template
A form for employees to enroll in or waive dental insurance coverage, with options for adding or dropping dependent coverage under COBRA.
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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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Employee Enrollment Form
PDF template
Comprehensive form for employee insurance enrollment with personal information and coverage details.
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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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Dental Insurance EnrollmentChange Form
PDF template
A form for employees to enroll in or modify dental insurance coverage, including dependent information and policy details.
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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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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
PDF template
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
PDF template
A mandatory dental health screening form for children entering public school in Kentucky, documenting dental health status and examination details.
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Patient Referral Form
PDF template
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
PDF template
Comprehensive medical history form collecting personal health information, medical background, and current health status.
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LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave, including medical, personal, and family leave.
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LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave, including medical, personal, and family leave.
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Dependent Audit Form
PDF template
A form for employees to verify and update dependent insurance coverage information and personal details.
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State Of Alaska Payroll Direct Deposit Form
PDF template
A form for Alaska state employees to set up or modify direct deposit arrangements for net pay and flat amount deposits.
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Physics And Astronomy Employee Business Expense Reimbursement Form
PDF template
Guidelines for submitting expense reimbursement forms for Physics and Astronomy department employees using a new electronic process through Workday Expenses.
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Dermatology Medical History
PDF template
Comprehensive medical history form for dermatology patients to document health conditions, medications, and allergies.
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DERMATOLOGY MEDICAL HISTORY FORM
PDF template
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
PDF template
Medical form for submitting wet or fresh tissue specimens for dermatopathology analysis and diagnostic testing.
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EmployeeS Withholding Certificate For City Of Detroit Income Tax
PDF template
Tax withholding form for employees working in Detroit, used to determine income tax exemptions and work locations.
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Shipping Assessment Form
PDF template
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
PDF template
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
PDF template
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
PDF template
Comprehensive medical history form for collecting patient personal information, contact details, and health status.
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Type 2 Diabetes Risk Assessment Form
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
A form for patients seeking physical therapy care, documenting current medical care status and providing medical record release consent.
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COPERS Direct Deposit Form
PDF template
A form for Phoenix city employees to set up direct deposit for their pension checks with banking details and authorization.
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Direct Deposit Form
PDF template
A form for Navajo Nation employees to set up or modify direct deposit banking information for payroll purposes.
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Direct Deposit Authorization And Cancellation Form
PDF template
A form for employees to set up, change, or cancel direct deposit banking information with Kaleida Health.
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Payroll Direct Deposit Form
PDF template
Form for employees to set up or modify direct deposit payroll payments at Hope College.
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M NCPPC Direct Deposit Form
PDF template
A form for Maryland-National Capital Park and Planning Commission employees to set up or modify direct deposit banking information for payroll.
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Direct Deposit Authorization Form
PDF template
Form authorizing automatic deposits and withdrawals to an employee's bank account by The University of the South.
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COVA Direct Deposit Form Directions
PDF template
Comprehensive guide for employees completing a direct deposit form, detailing required fields and submission process for the Commonwealth of Virginia payroll system.
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COVA Direct Deposit Form Instructions
PDF template
Instructions for completing a direct deposit form for employees, covering required fields and submission guidelines.
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Direct Deposit Form
PDF template
A form for employees to set up, modify, or cancel direct deposit of their payroll earnings with their financial institution.
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COVA Direct Deposit Form
PDF template
Guidelines for completing a direct deposit form for Commonwealth of Virginia employees, detailing required information and submission process.
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COVA Direct Deposit Form Instructions
PDF template
Detailed instructions for employees and agencies completing a direct deposit form for payroll purposes.
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CITY OF KAUKAUNA DIRECT DEPOSIT FORM
PDF template
A form for employees to set up direct deposit of their paycheck into one or multiple bank accounts.
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Direct Deposit Authorization Form
PDF template
A form allowing employees to authorize direct deposit of their paycheck into one or more bank accounts.
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Payroll Direct Deposit Form
PDF template
Form authorizing direct deposit of employee payroll payments for West Virginia University employees
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Direct Deposit Authorization Form
PDF template
A form authorizing electronic transmission of payroll funds to an employee's bank account at Widener University.
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Hollins UniversityADP Direct Deposit Authorization Form
PDF template
A form for Hollins University employees and students to set up or modify direct deposit banking information for payroll and reimbursements.
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Vanderbilt University Direct Deposit Authorization Form
PDF template
A form authorizing Vanderbilt University to deposit payroll funds into specified bank accounts
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Direct Deposit Form
PDF template
Form for employees to authorize direct deposit of flexible spending reimbursements through Auxiant.
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Authorization For Direct Deposit
PDF template
Form authorizing City of Boise employees to set up direct deposit for wage payments and reimbursements.
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Direct Deposit Form
PDF template
A form for employees to set up direct deposit of payroll checks with their employer and financial institution.
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Direct Deposit Authorization Form
PDF template
Form for employees to provide banking details for payroll direct deposit at Blue Ridge Community College.
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Direct Deposit Employee Authorization Form
PDF template
A form for employees to authorize automatic payroll deposits into bank accounts, including options for new, changed, or additional deposits.
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SPLLC Direct Deposit Form
PDF template
Form for employees to provide bank account details for direct deposit of payroll earnings.
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EMPLOYEE DIRECT DEPOSIT ENROLLMENT FORM
PDF template
A form allowing employees to set up direct deposit of their paycheck with bank account details and authorization.
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Authorization Agreement For Direct Deposits
PDF template
A form allowing employees to set up direct deposit of their paycheck with bank account details and authorization.
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Employer Authorization Direct Deposit Form
PDF template
A form allowing employees to authorize direct deposit of their payroll into a bank account at Webster Bank.
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Direct Deposit Form
PDF template
A form for employees to set up, change, or cancel direct deposit of their paycheck into a financial institution account.
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Direct Deposit Authorization
PDF template
A form for employees to set up, modify, or cancel direct deposit banking information for payroll purposes.
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Direct Deposit Enrollment Form
PDF template
A form allowing employees to set up direct deposit of their paycheck into bank accounts with authorization and account details.
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Authorization Agreement For Direct Deposit
PDF template
A form for employees to authorize direct deposit of their paycheck into one or more bank accounts.
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Payroll Direct Deposit Authorization Form
PDF template
A form for employees to set up or modify direct deposit banking information for payroll at Coquille School District
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Electronic Direct Deposit Authorization Agreement For Pre Authorized CreditsDebits
PDF template
A form for employees to authorize electronic direct deposit of payroll funds into their bank account(s)
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Direct Deposit Authorization Form
PDF template
A form for employees to authorize electronic paycheck direct deposit into one or more bank accounts.
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Payroll Direct Deposit Authorization Form
PDF template
Form for University System of New Hampshire employees to authorize electronic direct deposit of fixed amounts from their paycheck.
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Direct Deposit Form For Related Entity Employees
PDF template
A form for employees to provide bank account details for receiving salary payments via direct deposit.
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Employee Direct Deposit Authorization Instructions
PDF template
Form for employees to set up automatic paycheck deposits into one or two bank accounts with verification requirements.
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Direct Deposit Authorization Agreement
PDF template
A form for employees of Natomas Unified School District to set up electronic paycheck deposits into a bank account.
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Direct Deposit Form
PDF template
Form for employees to provide bank account details for direct deposit of payroll earnings.
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University System Of New Hampshire Payroll Direct Deposit Authorization Form
PDF template
A form for employees to authorize electronic direct deposit of payroll and reimbursement payments by the University System of New Hampshire.
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Direct Deposit Application
PDF template
A form for Harnett County employees to set up or modify direct deposit of their paychecks to their chosen financial institution.
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Direct Deposit Authorization Form
PDF template
A form for employees to authorize direct deposit of wages to a bank account, with options to start, stop, or change existing direct deposit arrangements.
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Direct Deposit Form
PDF template
Form for employees to provide bank account details for payroll direct deposit, allowing setup of primary and optional secondary accounts.
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Self Service Direct Deposit
PDF template
Instructions for employees to set up or modify direct deposit through the Employee Dashboard in Porches/HR system.
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Direct Deposit Worksheet
PDF template
A form allowing employees to set up direct deposit for their paycheck with multiple bank account options
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Request For Direct Deposit Form
PDF template
A form for employees to set up direct deposit of their payroll funds with Haverhill Public Schools.
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Direct Deposit Form Direct Deposit Switch Kit Form
PDF template
A form to authorize direct deposit of payroll or credits into an employee's Abbey Credit Union account
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Direct Deposit Worksheet
PDF template
Form for employees to set up direct deposit bank information for payroll services with multiple account options.
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Direct Deposit Form For NYS Employees
PDF template
A form for New York State employees to set up or modify direct deposit banking information for salary payments.
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Directed Quarantine Leave Request Form
PDF template
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
PDF template
Detailed guide for completing and submitting athlete registration and medical documentation for participation.
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Columbus County Direct Deposit Form
PDF template
Form for employees to authorize direct deposit of payroll funds into their bank accounts.
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DOTM FORM DAL Request Form
PDF template
A form for employees to request COVID-19-related leave under the Department of Military's Directors Authorized Leave policy.
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Molina Healthcare Of California Direct Referral To Specialist
PDF template
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
PDF template
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
PDF template
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
PDF template
Claim form for submitting a disability benefit request for IUOE Local 132 Health and Welfare Fund participants
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Disability Claim Form
PDF template
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
PDF template
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
PDF template
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
PDF template
Comprehensive instructions for filing a disability insurance claim with sections for physician, claimant, and employer statements.
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Disability Claim Form
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
Application packet for submitting a long-term disability benefits claim, including instructions for completing required forms.
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Adapted Physical Education Program Medical Form
PDF template
Medical form documenting student's disability, exercise limitations, and physical capabilities for adapted physical education program participation.
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How To File A Claim For Weekly Disability Benefits
PDF template
Comprehensive guide for filing a disability benefits claim, including required documentation and medical certification requirements.
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Discharge Form
PDF template
A form used to document patient discharge from a healthcare facility with multiple completion options.
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Discharge And Follow Up Recommendations
PDF template
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
PDF template
A comprehensive protocol detailing the procedures and responsibilities for patient discharge from an inpatient healthcare facility.
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Pediatric Discharge Summary Template
PDF template
A comprehensive template and instructions for creating a pediatric patient discharge summary with detailed guidelines for documentation.
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Documenting Discipline Issues
PDF template
A comprehensive checklist for managers to properly document employee disciplinary actions and performance issues.
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NON UNIFORM EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document recording an employee's demotion and the reasons for disciplinary action.
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Waccamaw EOC, Inc. Disciplinary Action Form
PDF template
A formal document used to record and document workplace misconduct and associated disciplinary measures for an employee.
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Disciplinary Action Form
PDF template
Official form for documenting employee disciplinary actions, including details of the disciplinary process and required signatures.
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Disciplinary Action Form
PDF template
A formal document used to document workplace misconduct, disciplinary actions, and performance issues for an employee.
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Disciplinary Action Form
PDF template
A form documenting performance issues and potential disciplinary actions for non-civil service employees.
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Payroll Deduction Authorization Form
PDF template
A form allowing FIU employees to authorize payroll deductions for summer camp registration expenses.
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DISCRETIONARY EXPENSE APPROVAL FORM
PDF template
A form for employees to request approval of discretionary expenses with detailed category breakdown and multiple levels of authorization.
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Discussion Period Request Form
PDF template
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
PDF template
Comprehensive medical form for collecting personal health information, emergency contacts, and medical history for international travel purposes.
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Exposure Risk Assessment Form
PDF template
A document assessing workplace exposure risks and mitigation strategies for David Douglas School District during the COVID-19 pandemic.
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MLML AAUS Diving Medical Form
PDF template
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
PDF template
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
PDF template
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
PDF template
A form requiring divers to prove they have medical insurance coverage for potential scuba diving accidents involving hyperbaric oxygen therapy.
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DIY Docs
PDF template
An online legal document creation and storage tool provided by ARAG for employees to generate and manage legal documents independently.
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DIZZINESS BALANCE MEDICAL HISTORY QUESTIONNAIRE
PDF template
Comprehensive medical questionnaire for patients experiencing dizziness, balance issues, and related symptoms
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NC Medicaid Hospice Prior Approval Authorization Form
PDF template
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
PDF template
Enrollment form for healthcare program participation, allowing individuals to enroll multiple people and select primary care providers.
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Employee Resignation Form
PDF template
Official form for employees to submit their resignation from College of the Mainland, documenting reasons and effective date of departure.
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Employee Resignation Form
PDF template
Official form for employees to submit their resignation from College of the Mainland, documenting reasons and effective date of departure.
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SAD AnnualPersonal Day Leave Request Form
PDF template
A form for service members to request annual or personal leave, documenting leave balances and obtaining approval from command.
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Referral
PDF template
A comprehensive medical referral document for tracking patient information and transfer of care between healthcare providers.
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DoctorS Signature Form
PDF template
A comprehensive medical form for documenting a camper's health information, medical history, medications, and physician details.
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Direct Deposit Form
PDF template
Form for employees to set up, change, or cancel direct deposit banking information for payroll at California State University Long Beach Research Foundation.
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Direct Deposit Form
PDF template
Form for employees to establish, modify, or cancel direct deposit banking instructions for payroll payments.
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Documenting The COVID 19 Pandemic In Windsor Submission Form
PDF template
A form for collecting historical documents, photos, and artifacts related to the COVID-19 pandemic in Windsor, Connecticut.
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Voting Leave Request
PDF template
A form for employees to request time off to vote in federal, state, or municipal elections, with supervisor approval.
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Authorization For The Release Of Health Information And Confidential HIV Related Information DOH 255
PDF template
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)
PDF template
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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Infectious Disease Requisition (IDR) Form Update
PDF template
Guidelines for healthcare providers and laboratories on collecting comprehensive demographic information for COVID-19 testing
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DOH COVID 19 Vaccination Consent Form
PDF template
A comprehensive form for capturing patient information and screening for COVID-19 vaccination eligibility and potential health risks.
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Asymptomatic Persons School COVID 19 Testing Consent Form
PDF template
A consent form for parents/guardians to allow COVID-19 testing of school children in Washington, DC by DC Health and DC Public Schools.
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COVID 19 Emergency Paid Leave (EPL) Employee Notification And Supplemental Leave Request Form
PDF template
Form for federal employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
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Leave Donation Request Form
PDF template
A form for employees to request donated leave during approved Family Medical Leave (FML) without pay periods.
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Donor Leave Request Form
PDF template
A form for employees to request leave for organ, blood, or other donation activities under the Kansas State Donor Program.
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INFORMED CONSENT TO DONATE EMBRYOSWAIVER OF LIABILITY
PDF template
Legal document for donating cryopreserved embryos to the National Embryo Donation Center for reproductive purposes.
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DONORRECIPIENT LEAVE REQUEST FORM
PDF template
A form allowing employees to donate personal or medical leave hours to another employee experiencing a catastrophic injury or illness.
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Do Not File Insurance Waiver Form
PDF template
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
PDF template
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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Disaster Leave
PDF template
Policy prescribing procedures for granting leave for disaster relief operations in support of the American Red Cross Memorandum of Understanding.
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Spot Award Nomination Form
PDF template
A form for nominating USC Dornsife employees for a performance recognition award with detailed nomination and eligibility criteria.
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TESTING REQUISITION FORM
PDF template
Specialized medical form for flow cytometry testing of blood and bone marrow specimens for various hematological conditions.
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Disciplinary Action Form
PDF template
A form used to document and submit disciplinary actions for employees within a civil service jurisdiction.
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Driver Medical History Form
PDF template
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
PDF template
Regulatory document specifying required electronic and paper billing formats for healthcare providers in workers' compensation and insurance contexts.
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Payroll Deduction Guide
PDF template
Comprehensive guide for employees and employers on setting up payroll deductions for the DreamAhead College Investment Plan.
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SOUTH DRIVE IN THEATER EVENT ATTENDANCE FORM
PDF template
A form for collecting attendee information for COVID-19 contact tracing at a drive-in event by Wexner Center for the Arts.
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Medical Certification Form New Driver Applicant
PDF template
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
PDF template
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
PDF template
A consent form for veterinary medical services and pet drop-off, including pet health status and treatment authorization.
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Drug Free Workplace Act Of 1988
PDF template
Policy prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances for college employees and students.
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Drug Testing Consent Form
PDF template
A comprehensive consent form for drug testing administered by the Manila Health Department Public Health Laboratory for various purposes.
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DSB 0311 Employee Administration Request Form
PDF template
Form for managing employee administrative actions for the NC Department of Health and Human Services Division of Services for the Blind.
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Medical Examination Form
PDF template
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)
PDF template
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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Contribution Form
PDF template
A bilingual form to determine financial contributions made by an individual to specific named persons.
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Online Inquiry Form
PDF template
A form for potential foster parents to express interest in providing foster care for youth and sibling groups.
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Informed Consent For Fitness Assessment
PDF template
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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UM Employee Gift Payroll Deduction Form
PDF template
A form allowing University of Michigan employees to authorize charitable donations through payroll deduction.
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DyAnsys Brief Proposal Form
PDF template
A comprehensive form for researchers seeking project support and equipment loan from DyAnsys, including project details and research objectives.
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Employee Benefit Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and vision benefit plans.
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Name AndOr Address Change Form
PDF template
Form for employees to request name or address changes within the Central Consolidated School District's HR department.
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Employee Academic Tuition Waiver Request Form
PDF template
A form for Cameron University employees to request tuition waivers for themselves or their dependents for academic courses.
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View And Update Your Federal Tax Withholding (Form W 4) In Employee Access
PDF template
Instructions for viewing and updating federal tax withholding information online using ADP Employee Access platform.
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Barcelona Portal Industry Booking Form
PDF template
Booking form for sponsorship and exhibition options at the EACTS 34th Annual Meeting virtual event in October 2020.
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EAF Contribution Form
PDF template
A form for Camelback employees to voluntarily contribute to the Employee Assistance Fund through payroll deductions.
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EagleOne Payroll Deduction Form
PDF template
Form for employees to request payroll deductions for their EagleOne account with specified amount options.
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EANS II Program Evaluation Form
PDF template
Evaluation form for non-public schools to document COVID-19 related assistance and impact of emergency educational support services.
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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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Sponsorship Exhibition Booking Form
PDF template
Booking form for sponsorship and exhibition opportunities at the European Breast Cancer Conference (EBCC)
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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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DIRECT DEPOSIT FORM
PDF template
Form for employees to specify bank account details for paycheck direct deposit distribution across up to three accounts.
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ECU COVID 19 Human Subject Research Risk Assessment Form
PDF template
A form to evaluate and classify research protocols based on COVID-19 exposure risk levels according to OSHA guidelines.
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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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Employee Declaration Form (EDF) Pay As You Earn (PAYE)
PDF template
Tax declaration form for employees in Mauritius to claim various tax reliefs, deductions, and allowances for the income year 2024-2025.
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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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Education And Professional Development Leave Application Form
PDF template
A form for Valencia College staff to request educational and professional development leave, including acknowledgement of policy terms and reporting requirements.
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Direct Deposit Authorization Form
PDF template
Form for employees to authorize electronic deposit of benefit reimbursements to a bank account
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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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Employee Agreement In Connection With Emergency Federal Employee Leave (EFEL)
PDF template
Employee agreement detailing conditions and responsibilities for receiving conditional emergency federal leave under the American Rescue Plan Act of 2021.
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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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IMPORTANT INFORMATION REGARDING INTERNATIONAL TRAVEL APPROVALS
PDF template
Comprehensive guidelines for domestic and international business travel, including COVID-19 considerations and approval processes for university faculty, staff, and students.
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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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American Rescue Plan Act (ARPA) Emergency Family Medical Leave Request Form
PDF template
A form for employees to request extended family medical leave related to COVID-19 under the American Rescue Plan Act.
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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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EFMP Family Support (EFMP FS) Needs Inquiry Form
PDF template
A comprehensive form for military families with special needs to assess support requirements and services
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Employee Actions EForm
PDF template
Comprehensive electronic form for managing various employee-related actions including hiring, transfers, pay changes, and terminations.
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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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STUDENT MEDICAL HISTORY
PDF template
Comprehensive medical history form for students, covering various health aspects and potential medical conditions.
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Consent Form For Electronic Distribution Of Benefit Materials And Notices
PDF template
A consent form allowing employees to receive electronic copies of benefit materials and notices from Michigan State University.
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RapidPayDirect Deposit Authorization Enrollment Form
PDF template
Form for Elmhurst University employees to set up direct deposit or RapidPay! Visa PayCard for receiving wages.
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Schools Covid 19 Risk Assessment
PDF template
A comprehensive risk assessment document for primary schools during the COVID-19 pandemic, addressing safety measures and potential hazards.
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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
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 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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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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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 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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Law Clerk Employee Data And Emergency Contact Form
PDF template
A form for collecting employee personal information and emergency contact details for law clerks in Maryland court system.
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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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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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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 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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Mennonite Village Covid 19 Earned Leave Request Form
PDF template
A form for employees to request leave due to positive COVID-19 test or related symptoms
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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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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 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
PDF template
Form for updating student emergency contact, insurance, and athletic participation information for school records.
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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
PDF template
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
PDF template
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
PDF template
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 Act Leave Request Form
PDF template
Employee form for requesting paid sick leave related to COVID-19 under the Emergency Paid Sick Leave Act.
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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 Paid Sick Leave Request
PDF template
Form for employees to request emergency paid sick leave under the Families First Coronavirus Response Act during the COVID-19 pandemic.
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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 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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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
PDF template
A form for parents to authorize emergency medical treatment for students and provide critical medical contact and health information.
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EMG ORDER FORM
PDF template
Medical referral form for ordering electromyography studies to diagnose nerve and muscle conditions.
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Emory Card Eagle Dollars Employee Payroll Deduction Form
PDF template
Form for Emory University employees to authorize payroll deductions for Eagle Dollars account
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Employee Equipment Loan Agreement
PDF template
A legal document for employees borrowing equipment from James Madison University, outlining responsibilities and conditions of equipment loan.
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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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HR 122 Employee Incident Report
PDF template
A detailed form for documenting workplace incidents and injuries for employees of Biggs Unified School District.
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EMPLOYEE ACKNOWLEDGEMENT FORM
PDF template
Form documenting employee understanding of background check requirements under California Assembly Bill 506 of 2021.
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Employee Acknowledgement Form
PDF template
A form acknowledging an employee's understanding of background check requirements under California Assembly Bill 506 of 2021.
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LIFT WHERE YOU STAND EMPLOYEE GIVING CAMPAIGN 2018 EMPLOYEE PAYROLL DEDUCTION FORM
PDF template
A form for employees to authorize charitable donations through payroll deductions for the annual giving campaign.
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Employee Bridge Of Service Review Form
PDF template
A form used to review an employee's service continuity and eligibility for service credit during multiple employment periods.
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Employee Change Of Address Form
PDF template
A form for employees to update their address and telephone number with the school district.
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BHSSC Employee Change Of Address Form
PDF template
A form for employees to update their personal contact information and address details with their employer.
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Complaint Form
PDF template
A form for employees to formally file workplace complaints or request informal resolution of workplace issues.
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Employee Complaint Resolution Procedure
PDF template
A formal procedure for resolving work-related employee concerns and complaints within the Technical College System of Georgia, ensuring fair treatment and communication.
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Employee Complaint Resolution Form
PDF template
A form for employees to document and submit workplace complaints, detailing issues and requested resolutions.
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EMPLOYEE COMPLAINT FORM
PDF template
A comprehensive form for employees to document workplace concerns including discrimination, harassment, ethical, or safety issues.
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VR FEE FOR SERVICE PROVIDER EMPLOYEE CONTACT FORM
PDF template
A form for documenting employee details and services for vocational rehabilitation providers
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EMPLOYEE CONTRIBUTION FORM
PDF template
A form allowing employees to establish, modify, or continue payroll deductions for foundation donations.
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Lamar Community College Foundation Employee Contribution Form
PDF template
A form allowing Lamar Community College employees to make monthly payroll donations to support student programs and college initiatives.
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Employee Course Registration Form
PDF template
Form for Gustavus employees to register for courses with tuition benefits, requiring HR and supervisor approvals.
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Employee Data Request Form
PDF template
A form for collecting comprehensive employee information to support the electronic appointment process in an organization's human resources workflow.
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NHRDeparture Employee Departure Information Sheet
PDF template
A comprehensive guide for faculty and staff leaving their position at the University of Wisconsin Madison, covering benefits, computer access, leave balances, and other departure-related information.
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Direct Deposit EnrollmentCancellation Form
PDF template
A form for employees to set up, change, or cancel direct deposit of payroll funds into bank accounts.
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EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee workplace violations, warnings, and disciplinary actions.
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EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee misconduct, performance issues, or policy violations in the workplace.
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Employee Disciplinary Action Form
PDF template
Formal document used to record and document workplace disciplinary actions and violations by employees.
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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 personal and emergency contact details for use in urgent situations.
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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 Evaluation Form
PDF template
A comprehensive employee performance assessment document with rating scales and sections for job knowledge, work quality, and goal setting.
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Employee Evaluation Form
PDF template
A comprehensive form for evaluating employee performance across multiple professional competencies and setting future goals.
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Employee Evaluation Form
PDF template
A comprehensive form for evaluating employee performance across multiple skill and competency areas.
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STATE OF KANSAS BIDDERS PREFERENCE PROGRAM EMPLOYEE EVALUATION FORM
PDF template
A form for documenting employee background, disabilities, and employment barriers for potential preference program eligibility.
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Employee Exit Checklist
PDF template
Comprehensive form documenting employee departure procedures, including credential return, benefits termination, and administrative tasks.
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Employee Exit Checklist Form
PDF template
A comprehensive form for managing employee separation process, ensuring return of district property and proper administrative procedures.
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Employee SeparationTransfer Checklist
PDF template
A comprehensive checklist for supervisors to manage employee departures or transfers, including access revocation and administrative procedures.
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Employee Travel Expense Report Form
PDF template
Form for documenting and requesting reimbursement of employee travel-related expenses by Claremore Public Schools.
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EMPLOYEE FEEDBACK FORM
PDF template
A comprehensive form for evaluating employee performance, identifying strengths, development needs, and creating an action plan for professional growth.
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Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for Health Savings Account contributions with annual contribution limits and details.
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Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for their Health Savings Account contributions with contribution limit details.
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Employee Information Change Form
PDF template
A form for employees to update their personal contact information with their employer's human resources department.
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Employee Information Form
PDF template
A comprehensive form for collecting personal, contact, demographic, veteran status, and educational background information for new employees.
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Employee Injury Report Form
PDF template
A form for documenting employee workplace injuries, incidents, and medical treatment details for workplace safety and insurance purposes.
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Employee Inquiry Form
PDF template
A form used by employees to submit inquiries to the Human Resource Services department at Newark Public Schools.
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Employee Internal Complaint Intake Form
PDF template
A form for reporting policy violations and discrimination complaints at St. Mary's College of Maryland.
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Record Of Employee Interview
PDF template
Confidential document for interviewing construction workers to verify employment details and compliance with labor standards.
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Employee Inventions Act
PDF template
Legal document governing employee inventions, service inventions, and technical improvement proposals in employment contexts.
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Warner Pacific University Employee Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including FMLA and OFLA leave options
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EMPLOYEE LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request and track various types of leave, compensatory time, and absence notifications.
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Employee Parking Policy
PDF template
Policy establishing parking provisions and regulations for county employees using county parking facilities and lots.
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Employee Of The Month Nomination Form
PDF template
A form for nominating employees in specific job categories for a monthly recognition award within an educational institution.
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Facilities And Campus Services Employees Of The Quarter Nomination Form
PDF template
A form for nominating exceptional employees or teams in the Facilities and Campus Services department who demonstrate outstanding performance and organizational values.
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Virginia Tech Employee Software Sales Order Form
PDF template
Order form for Virginia Tech employees to purchase software and technology accessories at discounted rates.
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Employee Paid And Unpaid Time Off Request Form
PDF template
A form for employees to request paid or unpaid time off, requiring approval from their supervisor.
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Employee Paid And Unpaid Time Off Request Form
PDF template
A form for employees to request paid or unpaid time off, requiring supervisor approval and documentation.
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EMPLOYEE PAYMENT AGREEMENT FORM
PDF template
A form for documenting an employee's payment schedule and financial obligations to an organization.
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Employee Payroll Deduction Form For Full Time Employees And Staff
PDF template
Form allowing employees to set up monthly charitable contributions through payroll deduction to Missouri State University Foundation
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Current Lincoln University Employee Payroll Deduction Form
PDF template
Form for Lincoln University employees to set up recurring payroll donations to the Lincoln University Foundation of PA
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UAB GIFT RECORDS EMPLOYEE PAYROLL DEDUCTION FORM
PDF template
A form for UAB employees to authorize automatic payroll deductions for charitable contributions to specific funds or programs.
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Employee Contribution And Payroll Deduction Form
PDF template
A form for employees to specify contribution amounts, payment methods, and recognition preferences for donations.
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Employee Contribution Form
PDF template
A form allowing employees to make charitable contributions through automatic payroll deductions to support Great Basin College scholarships and programs.
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Employee Payroll Deduction Form
PDF template
A payroll deduction authorization form for employees to contribute to the Germanna Community College Educational Foundation
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Staff Appraisal
PDF template
A comprehensive employee performance review document for documenting and evaluating staff performance, goals, and development
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Employee Performance Evaluation Form
PDF template
A comprehensive performance evaluation form for assessing employee job performance, development, and potential promotion opportunities.
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Request For Prescription Delivery
PDF template
A form for employees to request prescription delivery with patient and delivery details.
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Employee Profile And Travel Form
PDF template
A comprehensive form for employees to update personal information, marital status, and travel privileges for family members.
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Employee Progress Performance Review
PDF template
A comprehensive employee performance review document for rating job performance, skills, and goal achievement.
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Employee Purchase Form
PDF template
A form allowing employees to purchase items and choose payment methods, including payroll deduction and credit card options.
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Employee Referral Form
PDF template
Form for employees to refer potential job candidates to Albert Einstein College of Medicine with guidelines for referral awards.
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Employee Referral Form
PDF template
A form for employees to refer potential candidates and participate in the company's referral bonus program.
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Employee Referral Program Referral Form
PDF template
A form for employees to refer potential job candidates to open positions within the organization.
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Employee Resignation Form
PDF template
Official form for employees to submit their resignation from Jackson County Public Schools, detailing reasons for leaving and effective date.
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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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Employee Retirement Contribution Form
PDF template
Form for employees to start, change, or suspend retirement plan contributions at Mountainland Technical College.
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Employee Performance Review Form
PDF template
A comprehensive form for assessing employee performance across multiple competency and behavioral dimensions with rating scales.
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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 Self Assessment Form
PDF template
A comprehensive self-evaluation form for employees to reflect on their job performance, achievements, and goals.
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Employee Self Service Guide
PDF template
Comprehensive guide for navigating the Employee Self Service (ESS) portal and accessing various employee-related resources and information.
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Form 43 Employee TransferSeparation Clearance Form
PDF template
A form used to document and track the clearance process for employees transferring departments or separating from the university.
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HR64 Employee Separation Checklist
PDF template
A comprehensive form documenting the process and requirements for an employee's exit from the organization, including equipment return and account deactivation.
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Employee Services FAQ Contact List
PDF template
A comprehensive contact reference for employees covering various HR topics, benefits, and service inquiries.
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Employee Status Requisition
PDF template
A document used to initiate and document changes in employee status within an organization's human resources processes.
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TIME OFF REQUEST FORM
PDF template
A form for employees to request and obtain approval for various types of time off from work.
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Employee Time Off Request
PDF template
A form for employees to request time off for various reasons, requiring supervisor approval.
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Employee Time Off Request Form
PDF template
A form for personal care assistants (PCAs) to request paid or unpaid time off, with requirements for submission and approval.
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Employee Time Off Request Form
PDF template
A form for employees to request time off, specifying type and duration of leave and requiring manager approval.
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Employee (StudentStaff) Timesheet
PDF template
A comprehensive timesheet form for tracking employee work hours across multiple weeks and shifts with absence code tracking.
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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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Eye Care Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in or modify eye care insurance coverage for themselves and dependents.
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Disciplinary Action Form
PDF template
A formal document used to record and document employee misconduct, policy violations, and disciplinary actions.
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Employee Write Up Forms Packet
PDF template
Comprehensive packet of forms for documenting employee workplace issues, complaints, and disciplinary actions.
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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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GIC Employment Status Change Form
PDF template
A form for documenting changes in employment status, leave of absence, and associated health insurance coverage elections.
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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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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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Contribution Form
PDF template
A form for employees to make voluntary donations to the Enhabit Cares Foundation through payroll deduction, check, or credit card.
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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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Application And Change Form For Delta Dental Individual And Family
PDF template
A comprehensive dental insurance enrollment form for individual and family coverage with personal and dependent information sections.
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Superior Dental Care Employee Enrollment Form
PDF template
Form for employees to enroll in dental and vision insurance benefits through Superior Dental Care.
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ENROLLMENT FORM GL.2017.010
PDF template
A comprehensive employee insurance enrollment form for selecting life and AD&D coverage options for employees and dependents.
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Enrollment Transfer Request Form
PDF template
A form for veterans to transfer their medical enrollment between VA healthcare facilities, capturing personal and contact information.
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California State University, Sacramento Benefit Enrollment Worksheet
PDF template
A form for employees to complete transactions affecting health, dental, vision, and FlexCash coverage at California State University, Sacramento.
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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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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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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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Employee Organization Leave Request And Reimbursement Form
PDF template
A form for public employees to request organization leave and reimbursement for specific meetings and circumstances.
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Employee Of The Month Nomination Form
PDF template
A form for nominating Jackson County employees for monthly recognition with specific eligibility criteria and rewards.
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Employer Of Record Time Sheet
PDF template
A timesheet form for tracking employee hours and services, particularly for respite care services.
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EPAR Timesheet
PDF template
A standard timesheet form for tracking employee work hours and payroll information.
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TIME OFF REQUEST FORM
PDF template
A form for employees to request vacation, sick, personal, or flex time with specific instructions and approval process.
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OMNI EPerformance Training AP EPerformance Quick Reference Supervisor And Employee Actions
PDF template
A step-by-step guide for supervisors and employees using the ePerformance evaluation system for performance reviews.
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Nomination And Declaration Form For Unexempted Exempted Establishments
PDF template
A form for employees to nominate beneficiaries for provident fund and pension scheme benefits in case of death.
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Episodic Medical Form
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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
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Form for employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
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Kenyon College Employee Performance Program Guide For Supervisors
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A comprehensive guide outlining Kenyon College's performance management process, including quarterly check-ins and triennial performance reviews.
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Equipment And Personal Items Inventory Form
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A form used to document institutional assets and personal items being returned by an employee during separation from UT Health San Antonio.
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ER 011 Vacation Time, Usage Of
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Policy establishing procedures for vacation time usage and eligibility for employees at Family Focus, Inc.
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ERaf Request Form
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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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LTBB Housing ERAP Application
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Housing assistance application for Little Traverse Bay Bands of Odawa Indians tribal members experiencing financial hardship due to COVID-19
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ERCS Kudos Corner Submission Form
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A form for employees to recognize and nominate colleagues for outstanding work in a monthly newsletter feature.
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College Of The Siskiyous Emergency Contact Form
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A form for collecting employee emergency contact information and contact preferences for information release.
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Employee Resource Document
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A comprehensive resource document for employees providing emergency contacts, academic information, and campus resources.
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Emergency Ride Home (ERH) Reimbursement Form
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Form for employees to request reimbursement for emergency transportation home under specific qualifying circumstances.
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NEW UPDATE IMPORTANT PAYROLL INFORMATION FOR ALL FACULTY AND STAFF
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Notification about the new PeopleSoft payroll system requiring all employees to submit time and leave requests electronically, eliminating traditional timecards and leave forms.
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ES 4316 EES InterviewScreen
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A screening form to evaluate employee eligibility for intervention services based on multiple risk factors
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Payroll Deduction Authorization Form For Panther Employee ScholarshipWaiver Program
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Authorization form for Prairie View A&M University employees to have tuition and fees deducted directly from their paycheck
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ESPEN RESEARCH FELLOWSHIPS 2020 APPLICATION FORM
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Application form for research fellowship funding from ESPEN, with detailed requirements for applicants and project details.
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ESP Performance Review
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A comprehensive evaluation form for assessing employee performance across multiple job characteristics and skills.
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ESRD Incident Or Accident Report Form
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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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Vehicle Registration Form
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A form for registering vehicles for employees at Vassar College, used to track campus parking and vehicle information.
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MEDICAL HISTORY FORM
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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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EMPLOYEE TIME OFF REQUEST FORM
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A form for employees to request various types of time off, including sick leave, vacation, and bereavement
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Carter County PERSONNEL PERFORMANCE REVIEW FORM
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A comprehensive form for evaluating employee performance across multiple job competency categories.
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Eviction Notice English
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A legal form allowing tenants to declare hardship and prevent eviction during the COVID-19 pandemic based on income loss or health risks.
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Eviction Protection Declaration
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A CDC-issued declaration form to provide temporary eviction protection for qualifying individuals experiencing financial hardship during the COVID-19 pandemic.
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Essential Travel Request Form
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A form for requesting essential travel by university faculty, staff, and students, with COVID-19 considerations and approval process.
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Piercing Consent Release Form
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Legal document providing informed consent for body piercing procedures, detailing risks and patient acknowledgments.
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MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
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A comprehensive medical insurance claim form for submitting healthcare reimbursement or coverage information.
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Primary Care EXERCISE CLINIC REFERRAL
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A medical referral form for patients seeking exercise physiology services, documenting health conditions and exercise participation eligibility.
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Catholic Identity Commitment Agreement
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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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Exhibit 409.3E2 EMPLOYEE FAMILY AND MEDICAL LEAVE REQUEST FORM
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A form for employees to request family and medical leave for various personal and family health-related reasons.
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Exhibit Covid 19 Protocols For Facilities Management Contractors
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Guidelines for contractors working on Wellesley College campus during the COVID-19 pandemic, outlining health and safety requirements.
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EXIT CHECKLIST
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A comprehensive form for employees to complete when leaving their position, covering key administrative and logistical tasks during the exit process.
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EMPLOYEE CLEARANCE CHECK LIST
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A comprehensive form for documenting an employee's departure from an organization, covering departmental clearance and separation details.
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Sick Leave Contribution Form
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A form allowing Stephen F. Austin State University employees to voluntarily donate sick leave or vacation leave to sick leave or family leave pools upon separation or while active.
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Stephen F. Austin State University ADDRESSNAME CHANGE FORM
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A form for university employees to update personal information including name, address, and contact details.
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G Adventures Confidential Medical Form
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A confidential medical form for travelers with pre-existing medical conditions to assess fitness for expedition travel.
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SEMA4 EMPLOYEE EXPENSE REPORT
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A form for employees to document and request reimbursement for travel-related expenses and mileage.
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EXPENSE REIMBURSEMENT PROCEDURES
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Comprehensive guidelines for employee expense reimbursement covering business expenses and travel, aligned with IRS accountable plan regulations.
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SEMA4 Employee Expense Report
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A comprehensive form for employees to report travel expenses, mileage, and other reimbursable costs for business trips.
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EXPENSE REPORT
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A form for employees to report and request reimbursement for work-related expenses, including travel and miscellaneous costs.
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SEMA4 Employee Expense Report
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A detailed form for documenting employee travel expenses, mileage reimbursement, and other related costs.
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Payroll Deduction Authorization Form
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Form for Florida International University (FIU) employees to authorize payroll deductions for summer camp registration and related services.
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Emergency ResponsePublic Safety Worker Incident Report Form
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A form for emergency response and public safety workers to document workplace exposure incidents and medical referral details.
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Hazardous Exposure To Blood And Other Body Fluids
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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
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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
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A form documenting potential medical exposure incidents for students during clinical training or placement.
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Exposure Risk Assessment Form
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A comprehensive form detailing COVID-19 safety measures and exposure risk mitigation strategies for school employees
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COVID 19 Virus Exposure Risk Assessment Form For Health Care Workers (HCW)
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A comprehensive form to evaluate potential COVID-19 virus exposure risks for healthcare workers during patient interactions.
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Express Benefit Report
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A form used to report accumulated unused sick leave balances and employment termination information for CalSTRS retirement benefits.
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EXTENDED LEAVE REQUEST FORM
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A comprehensive form for employees to request extended leave, including details about leave type, duration, and supporting documentation.
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GPSI Extended Leave Form
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Form for GPSI interns to request extended leave with specific allowances based on intern year.
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Texas City ISD Extended Leave Request Form
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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
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A form for documenting and tracking tissue sample shipments to the Human Tissue Resource Center at the University of Chicago.
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External Employment And Consulting Leave Request Form
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A form for Texas A&M University-Kingsville employees to request leave for external employment or consulting activities.
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Laser Eye Examination Form
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Medical form for documenting laser user eye examination and medical history related to laser exposure risks.
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Eyeglass Reimbursement Form
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A form for employees to request reimbursement for eyeglass purchases through the school district's benefits program.
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EnrollmentChange Form
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A form for enrolling or changing employee and family insurance coverage with Fidelity Security Life Insurance Company.
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EnrollmentChange Form
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Insurance enrollment and change form for employees and their family members, underwritten by Fidelity Security Life Insurance Company.
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CCP Prior Authorization Request Form
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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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Direct Deposit Request Form
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Form for employees to request direct deposit of paycheck into bank account(s)
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LEAP Testing Service Sample Submission Form
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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
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Detailed instructions for completing a mandatory consent form for sterilization procedures under Wisconsin's ForwardHealth program.
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Change Of Address Form
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A form for members to update their mailing address for various trust fund communications and services.
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All Of Us Research Program Sample Consent Form
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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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F245 145 000 Travel Reimbursement Request
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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
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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
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Comprehensive claim form for medical, dental, vision, prescription, and weekly disability benefits for NW Plumbers & Pipefitters Health Fund members.
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Change Of Address Form
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A form for employees to update their contact information with the Puget Sound Electrical Workers Trust Funds.
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Form WT 4A Worksheet For Employee Withholding Agreement
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A worksheet for employees to adjust their income tax withholding for 2015 in Wisconsin based on estimated tax liability.
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Change Of Address Form
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A form for employees to update their personal contact information with the Engineers-AGC Retirement Trust
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FAA Child Care Subsidy Program Monthly Invoice Form
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A form for FAA employees to submit monthly child care service costs and receive subsidy reimbursement.
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FAA Student Coaching And Feedback Form
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A documentation form for supervisor-employee conversations regarding performance coaching and feedback at the FAA.
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Comprehensive Medical Examination Checklist
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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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Appendix 1 To FAA NATCA FFCRA MOU
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A document for employees to request emergency leave related to COVID-19 under the Families First Coronavirus Response Act.
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Mini Grant Application Form
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Application form for the Office of Family and Community Engagement mini-grant program to support school community activities.
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Contract Intelligence
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An advanced AI system for automated, high-precision extraction of key information from complex contracts using neuroscience-based technology.
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FACULTY LEAVE AND CLINIC CANCELLATION FORM
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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
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A comprehensive form for faculty members to request various types of leave, including medical, family, parental, and extended leaves.
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REQUEST FOR LEAVE OF ABSENCE
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A form for employees to request various types of leave, including medical, family, and personal leave of absence.
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Faculty Scholarly And Creative Activity Leave Application
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A comprehensive application for faculty members requesting scholarly and creative activity leave at Winston-Salem State University for the 2022-2023 academic year.
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Faculty Staff Campaign Payroll Deduction
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A form for Anna Maria College employees to authorize payroll deductions for charitable giving to the institution.
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Payroll Deduction Form
PDF template
A document allowing employees to authorize monthly or one-time payroll deductions for university donations and support various campus programs and funds.
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Fall 2020 COVID 19 Campus Operations Update
PDF template
Comprehensive guide detailing campus operations, class delivery methods, and COVID-19 safety protocols for fall 2020 semester.
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Emergency Sick Leave Request
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A form for employees to request emergency sick leave due to COVID-19 related reasons between April 1 and December 31, 2020.
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Families First Coronavirus Response Act (FFCRA) Family Medical Leave (FML) Request
PDF template
A document for employees to request expanded family medical leave under the Coronavirus Response Act, covering leave periods between April 1 and December 31, 2020.
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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
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A form for collecting contact details for parents or guardians of a child or student.
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Family Contact Form
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Form for collecting comprehensive contact and insurance details for a client's family members and guardians.
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Family Contribution
PDF template
A document used to verify and document financial contributions from a provider to an applicant or participant.
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FAMILY EMERGENCY CONTACT FORM
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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 Health Leave Request Form
PDF template
A form for employees to request family health leave in accordance with FMLA regulations at Cornell University.
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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 Medical Leave Request Form
PDF template
A form for Rappahannock County Public Schools employees to request family or medical leave with required documentation from healthcare providers.
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Michigan Department Of Natural Resources Annual Family Membership Application
PDF template
Annual family membership application for the Michigan Department of Natural Resources Outdoor Adventure Center, allowing up to five family members free admission for one year.
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Family Notification Of Death, Injury, Or Illness In Custody Act Of 2022
PDF template
A bill to establish federal policies for notifying next-of-kin when an individual dies, becomes seriously ill, or is seriously injured while in federal custody.
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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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APPLICATION FOR GRANT OF FAMILY PENSION
PDF template
Application form for requesting family pension benefits from Bank of Baroda Pension Fund Trust after the death of a pensioner.
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Family Resilience Fund Referral Form
PDF template
A referral form for families who have lost a primary caregiver to Covid-19 and are experiencing financial hardship.
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FAMILY SUPPORT ORDER FORM
PDF template
Order form for families receiving developmental disability support services to request specific items and supplies.
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Family Values Survey Form
PDF template
A comprehensive survey for parents to provide detailed information about their child's educational needs, strengths, interests, and family background.
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FAQs For The Back To Business Illinois Creative Arts Recovery Grant Program (B2B Arts)
PDF template
Frequently asked questions document providing details about the Illinois Creative Arts Recovery Grant Program for businesses impacted by COVID-19.
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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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FAQ For Student Organizations
PDF template
Guidelines for student organizations during the COVID-19 pandemic, providing guidance on meetings, events, and new member education for Spring 2021
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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
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Comprehensive medical intake form for urogynecology patients to document urinary and bowel symptoms, medical history, and patient goals.
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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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Federal Paid Sick Leave Expanded Family And Medical Leave Request Form
PDF template
Employee form for requesting paid sick leave related to COVID-19 circumstances and documenting eligibility for leave
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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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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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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 LEAVE REQUEST FORM
PDF template
Form for employees to request leave under the Families First Coronavirus Response Act for COVID-19 related reasons
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Leave Request Form Families First Coronavirus Response Act Employee Paid Leave
PDF template
A form for employees to request paid or unpaid leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
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FFCRA Leave Request Form
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) for COVID-19 related reasons.
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Families First Coronavirus Response Act (FFCRA) Leave Request
PDF template
Form for employees to request paid sick leave and expanded family medical leave related to COVID-19 pandemic
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COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave due to COVID-19 related reasons under the Emergency Paid Sick Leave Act.
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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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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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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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UHC WTIA (EnrollCancelWaiverChanges)
PDF template
A comprehensive form for employees to enroll, modify, or cancel health insurance benefits and personal information.
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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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AccidentIncident Report Form
PDF template
A comprehensive form for documenting workplace accidents, incidents, and related details for reporting and prevention purposes.
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Confidentiality Agreement
PDF template
A comprehensive confidentiality agreement outlining information protection requirements for employees and contractors of A & T.
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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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Direct Deposit Form For NYS Employees
PDF template
A form for New York State employees to set up, modify, or cancel direct deposit of their salary into bank accounts.
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Redemption Chapel Payroll Direct Deposit Form
PDF template
A form for employees to provide bank account details for direct deposit of payroll earnings.
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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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Emergency Rental Assistance Program (ERAP) Application
PDF template
Application for emergency rental and utility assistance for households experiencing financial hardship due to COVID-19 outbreak.
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LTBB Housing ERAP Application
PDF template
Application for rental assistance program by Little Traverse Bay Bands of Odawa Indians for households impacted by COVID-19
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Emergency Rental Assistance Program (ERAP) Application
PDF template
Application for rental and utility assistance for households experiencing financial hardship due to the COVID-19 outbreak
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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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An In Home Family Therapy Program Referral Form
PDF template
A comprehensive referral form for in-home and telehealth family therapy services with detailed client and insurance information collection.
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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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Loan Application Form
PDF template
A loan application form for University of the Philippines employees with different loan amount limits based on employee classification.
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GWA FFCRA EXPANDED FMLA LEAVE REQUEST
PDF template
Form for employees to request expanded FMLA leave under the Families First Coronavirus Response Act due to child care needs during COVID-19 pandemic.
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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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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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Membership Form
PDF template
A comprehensive membership form for registering individuals and families with Christ Episcopal Church in Kensington, Maryland.
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NEW CLIENT INFORMATION PAYMENT AGREEMENT
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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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Nursing Recruitment Relocation Bonus Program Application
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Application for nurses relocating to West Virginia to receive a $12,000 bonus for one year of full-time nursing service in specific healthcare facilities.
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FILLABLE ORDER FORM FOR SFP 7 17 CURRICULUM AND MATERIALS
PDF template
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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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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Sick Leave Request Form
PDF template
A form for employees to request sick leave and associated pay, to be processed by the payroll department.
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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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TIME OFF REQUEST FORM
PDF template
A form for employees to request time off for various reasons including vacation, sick leave, or personal reasons.
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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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Stay At Home Rethinking Rental Housing Law In An Era Of Pandemic
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An academic article examining eviction laws, housing insecurity, and the impact of COVID-19 on tenants and housing policy.
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PCC District Wide Exposure Risk Assessment Form
PDF template
Risk assessment document for evaluating COVID-19 exposure controls and procedures at Portland Community College during the Resumption Phase.
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Finance Forum Notes
PDF template
Internal meeting notes covering student employment I-9 process, IT training, year-end fiscal activities, and department invoicing procedures.
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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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Mansfield Independent School District Business Procedures Manual, Section 6 EmployeeStudent Travel
PDF template
Detailed guidelines for travel expenses, reimbursement, and approval process for Mansfield Independent School District employees and students.
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Suburban Urologic Associates Financial Policy
PDF template
Detailed financial policy outlining insurance, payment, and billing procedures for a urology medical practice.
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Type 2 Diabetes Risk Assessment Form
PDF template
A comprehensive questionnaire to assess an individual's risk of developing type 2 diabetes within the next 10 years.
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Sick Leave 40 Hour Employees
PDF template
Procedure defining responsibilities and guidelines for sick leave management for 40-hour fire department personnel.
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First Time Appointment Billing Form
PDF template
A billing form for documenting client details, service type, and appointment information for a first-time healthcare consultation.
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COVID 19 Paid Sick Leave Act Request Form
PDF template
Form for employees to request paid sick leave due to COVID-19 quarantine or isolation orders in New York State.
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Employee Voluntary Payroll Deduction Authorization For Fitness Center Usage Fee
PDF template
Voluntary authorization form for employees to have fitness center usage fee deducted from their paycheck
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Payroll Deduction For Fitness Center Membership
PDF template
A form for employees to authorize payroll deductions for fitness center membership at Clayton State University.
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Sick Leave For Fitness Program Authorization Payment Form
PDF template
Form for City of Austin employees to request reimbursement for fitness-related expenses using sick leave credits, with a maximum annual reimbursement of $2,000.
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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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Payroll Deduction Form For The SSU Employee Fitness Plan
PDF template
Form for faculty and staff to enroll in Savannah State University's fitness plan with payroll deduction options.
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2024 Fitness Reimbursement Program
PDF template
A program offering up to $300 per family annually for eligible fitness expenses for University System of New Hampshire employees and dependents.
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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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Direct Deposit Authorization
PDF template
A form for employees to authorize direct deposit of payments or reimbursements with bank account details.
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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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BESTflex Plan Election Form
PDF template
Document for employees to elect participation in flexible spending accounts for healthcare and dependent care expenses
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FLUOROSCOPY AND INTERVENTIONAL REQUISITION
PDF template
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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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
PDF template
Medical test requisition form for transplant patient diagnostic testing with comprehensive patient and billing information collection.
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FM EXP TravelAuthorizationForm 001
PDF template
A form for obtaining prior authorization for out-of-state or out-of-country employee travel with specific conditions and usage guidelines.
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Hospital Discharge Plan For Tuberculosis Patients
PDF template
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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FAMILY MEDICAL LEAVE EMPLOYEE LEAVE REQUEST FORM
PDF template
A form for employees to request medical or family leave under FMLA and NJFLA regulations, documenting eligibility and reasons for leave.
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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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City Of Round Rock Request For FMLA Leave
PDF template
Official document for City of Round Rock employees to request Family and Medical Leave Act (FMLA) leave for various personal and family health situations.
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Leave Request Form Federal COVID 19 FFCRA
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) for COVID-19 related 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 employees to request job-protected leave under the federal Family and Medical Leave Act for various qualifying reasons.
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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 MEDICAL LEAVE (FMLA) REQUEST FORM
PDF template
A form for employees to request Family and Medical Leave Act (FMLA) leave for various qualifying reasons including personal or family medical conditions, birth, adoption, or military-related leave.
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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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FMLALOA Leave Request Process
PDF template
Comprehensive guide for employees requesting Family and Medical Leave Act (FMLA) leave, detailing submission process and requirements.
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HR FMLAOFLA Leave Request
PDF template
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 comprehensive form for employees to request family and medical leave, including parental leave, for various qualifying reasons.
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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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Family And Medical Leave (FML) Request Form
PDF template
A form for employees to request Family and Medical Leave, detailing the type and reason for leave under FMLA guidelines.
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Family Or Medical Leave Request Form
PDF template
A form for employees to request family or medical leave, detailing the type, duration, and conditions of leave
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FNIS Request Form
PDF template
Form for nonresident employees and students to provide immigration and personal information for tax withholding purposes at Northwestern University.
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U.S. BANK FOCUS CARD Enrollment Form
PDF template
Enrollment form for obtaining a U.S. Bank Focus Card with personal and employment information collection
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Service Request Form
PDF template
A form for requesting information or search services related to adoption records from the Illinois Department of Children and Family Services.
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IDCFS Closed File Information And Search Service Request Form
PDF template
A form for individuals seeking information or search services related to adoption records maintained by the Illinois Department of Children and Family Services.
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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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FOOTWEAR SELECTION AND PROCUREMENT PROCEDURE
PDF template
Procedure for selecting and procuring protective footwear for employees with safety requirements and reimbursement guidelines.
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MortgagorS Declaration Of COVID 19 Related Hardship
PDF template
A legal form allowing mortgagors to declare financial hardship during the COVID-19 pandemic and temporarily prevent foreclosure.
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Foreign Change Of Address Form
PDF template
Form for updating international employee address and tax document delivery preferences at the University of Pittsburgh.
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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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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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Form 11 LEAVE REQUEST FORM
PDF template
A form for employees to request various types of leave, including vacation, sick, and compensation time, with supervisor approval.
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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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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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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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PPP LOAN APPLICATION FORM 3508EZ
PDF template
A comprehensive form for small businesses to apply for forgiveness of Paycheck Protection Program (PPP) loans with detailed documentation requirements.
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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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Withdrawal Request
PDF template
A form for withdrawing a claim under the Mashantucket Pequot Family and Medical Leave Law.
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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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FORM 68 EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee workplace violations and disciplinary actions.
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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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Medical ControlPhysician Contact Hour Attendance Form
PDF template
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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Commonwealth Of Massachusetts EMPLOYEE REIMBURSEMENT FORM
PDF template
A form for Massachusetts state employees to submit expenses and mileage for reimbursement, including private auto mileage, meals, fares, and other expenses.
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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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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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COVID Vendor And Contractor Vaccination Status Submission Form Instructions
PDF template
Instructions for vendors and contractors to submit COVID-19 vaccination status for employees working at UNC Health locations
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Accident Investigation Form (Example 2)
PDF template
A comprehensive form for documenting and investigating workplace accidents, collecting details about the incident, affected employee, and supervisor's assessment.
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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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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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Planning And Evaluation Form
PDF template
A comprehensive form for documenting employee performance goals, objectives, and achievements for an annual performance review cycle.
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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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VacationPaid Time Off Advance Agreement
PDF template
An agreement allowing employees to receive advanced vacation pay during the COVID-19 pandemic, to be repaid through future vacation earnings.
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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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Form R Retiree Request Form
PDF template
A form for FedEx retirees to request travel tickets for themselves and eligible dependents using travel benefits.
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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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Messiah University Form Collection
PDF template
A comprehensive list of administrative forms used across various departments at Messiah University for different financial and administrative purposes.
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Shared Leave Program Procedure And Request Form
PDF template
A comprehensive procedure for Pierce College District employees to donate and receive leave time under specific qualifying circumstances.
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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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Leave Request
PDF template
A form for employees to request various types of leave with options for paid and unpaid leave categories.
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StudentSADD Dataset End User License Agreement
PDF template
License agreement for accessing and using the StudentSADD research database on student mental health during the COVID-19 pandemic.
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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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Workplace Complaint Form
PDF template
A form for filing workplace complaints by employees at a university medical center, detailing procedures for submitting grievances through Employee and Labor Relations.
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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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Gift Authorization Form Employee Payroll Deduction
PDF template
A form allowing employees of Yuba Community College District to authorize recurring payroll deductions for foundation gifts and scholarships.
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Employee Donation Payroll Deduction Form
PDF template
A form for employees to make charitable donations to support various initiatives at the OCCC Foundation through payroll deductions or one-time gifts.
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Employee Payroll Deduction Pledge Form
PDF template
A form allowing employees to authorize recurring payroll deductions for charitable donations to the college foundation.
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Payroll Deduction AuthorizationChange Form
PDF template
A form for Pierce College employees to authorize payroll deductions for charitable donations to the Legacy of Excellence Fund.
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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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PATIENT INTAKE FORM
PDF template
Comprehensive medical history and current health status form for patient therapy intake and medical assessment.
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Employee Performance Review
PDF template
A comprehensive form for assessing employee performance across multiple professional competencies and skills.
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Employee Performance Review
PDF template
A comprehensive document for assessing employee job performance across multiple professional competencies and behaviors
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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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Time Off Request Form
PDF template
A form for employees to request and record time off from work, requiring supervisor and manager approval.
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Time Off Request Form Hourly
PDF template
A form for hourly employees to request and track paid time off hours based on service tenure and average worked hours.
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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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Consent For COVID 19 Immunization
PDF template
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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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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Freshmen Christian Service Requirements
PDF template
Guidelines for freshmen to complete 10 hours of Christian service focused on intentional, meaningful interactions with family members.
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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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Section 125 Flexible Benefit Plan Direct Deposit Form
PDF template
A form for employees to authorize direct deposit of flexible benefit plan funds to a designated bank account.
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2024 Flexible Spending Account EnrollmentChange Form
PDF template
A form for employees to enroll in or modify their Flexible Spending Account benefits for healthcare and dependent care expenses
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Health And Dependent Day Care Reimbursement Form
PDF template
Form for submitting health care and dependent day care expense claims under a Section 125 Cafeteria Plan for reimbursement.
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Recurring Claim Form
PDF template
A form for employees to automate reimbursement of qualified expenses with fixed payments to a service provider.
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Discrimination Complaint Form
PDF template
Form for reporting discrimination complaints by students, employees, or other individuals within the college community.
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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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Virginia Tech Employee Software Sales Order Form
PDF template
A form for Virginia Tech employees to purchase software licenses and technology accessories at discounted rates.
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RMBL Leave Request
PDF template
A form for employees to request leave, documenting paid or unpaid time off and supervisor approval.
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CareDx Transplant Test Requisition Form
PDF template
Medical form for ordering transplant-related diagnostic testing with patient and clinical information details
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CareDx Lung Transplant Test Requisition Form
PDF template
Medical form for ordering diagnostic testing for lung transplant patients, used to track patient information and test requirements.
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Discharge Form
PDF template
A comprehensive form for tracking patient discharge details, follow-up care, and medical conditions in a healthcare setting.
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Funeral, Bereavement And Pregnancy Loss Leave Request Form
PDF template
A form for employees to request bereavement or pregnancy loss leave, allowing up to three days of paid leave with potential for additional travel time.
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Funeral Home Reimbursement Form
PDF template
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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ORGANIZATION OF STAFF ANALYSTS FURLOUGH SURVEY FORM
PDF template
Survey form for staff members to indicate interest in taking a voluntary leave of absence with potential health benefit considerations.
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FURLOUGH SURVEY FORM
PDF template
Survey form for staff analysts to indicate interest in taking a leave of absence with health benefit conditions.
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MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal information, medical history, and dental visit details
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Pre Authorization Form
PDF template
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
PDF template
A county health department form for documenting medical transportation needs and patient transfer details for medical assistance recipients.
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HDOA Seafood Processors Pandemic Response Form A
PDF template
Application form for seafood processors seeking reimbursement for COVID-19 related costs under USDA block grant program.
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Benefits Open Enrollment Form 2020
PDF template
Form for employees to select or modify healthcare coverage options and provide personal information for benefits enrollment.
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Patient Interview Form
PDF template
Comprehensive medical intake form for collecting patient demographic, health history, and contact information.
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GAANN Fellowship Application Form
PDF template
Application form for GAANN Fellowship at FIU, focused on AI and Cybersecurity research doctoral programs.
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Gannon University Health Examination Form
PDF template
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
PDF template
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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Time Off Request Form
PDF template
A form for employees to request personal or sick time off, with details about coverage and documentation.
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Gastrointestinal Order Form
PDF template
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
PDF template
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
PDF template
Enrollment form for healthcare providers to prescribe and administer Nucala medication, including prescriber and clinical information.
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MedicalEmergency Information And Waiver Of Liability And Parental Consent Form
PDF template
A comprehensive medical information and liability waiver form for participants in Great Bay Rowing activities, collecting emergency contact details and medical history.
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Authorization Disclosure Of Confidential Information
PDF template
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
PDF template
Comprehensive medical intake form for counseling services, collecting patient personal and insurance information.
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Medical Claim Form
PDF template
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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YMAHE Health Assessment Form
PDF template
Comprehensive health assessment form for first-year students requiring medical history, vaccination records, and physical examination details.
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Request For Leave Of Absence Form
PDF template
A comprehensive form for employees to request leave of absence for various personal and family reasons, including documentation requirements.
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Bridge To Wellness Wellbeing Program General Medical Form
PDF template
A form for employees to document preventative medical, dental, eye, and dermatology examinations for a workplace wellness program.
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GENERAL REFERRAL FORM
PDF template
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
PDF template
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
PDF template
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
PDF template
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
PDF template
A comprehensive consent form template for medical research studies detailing participant rights and study participation guidelines.
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NatWest Mentor Services General Risk Assessment Form
PDF template
Risk assessment document for Covid-19 workplace safety at NatWest Mentor Services Main Building
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General Test Requisition
PDF template
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
PDF template
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
PDF template
A comprehensive form for collecting patient information and consent for vaccination at Walgreens.
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MEDICAL HISTORY AND RELEASE FORM
PDF template
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
PDF template
A comprehensive medical referral form for routing patients to various medical specialties at Emory Healthcare.
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Personal Vehicle Use Form
PDF template
Form documenting employee personal vehicle usage and insurance details for official district business and field trips.
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Patient Intake Form
PDF template
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
PDF template
Comprehensive medical intake form for new chiropractic patients, collecting personal information and detailed health history.
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Laboratory Specimen Collection Form
PDF template
A detailed form for collecting patient and specimen information for laboratory testing and analysis.
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Employer Notice Of Claim Long Term Disability
PDF template
A comprehensive claim package for employers to submit long-term disability claims for employees, including detailed instructions and employee information sections.
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Short Term Disability Claim Form
PDF template
A form for employees to file a claim for short-term disability benefits, documenting medical leave and disability details.
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Quartz Medicare Advantage (HMO) Quartz CashCard Reimbursement Form
PDF template
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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Payroll Deduction Form For Charitable Contributions To The University Of California, Santa Barbara
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A form allowing employees to set up monthly charitable contributions to the UCSB Foundation's Sustainable Transportation Fund through payroll deduction.
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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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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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Addendum To Purchase Agreement COVID 19 Event Extension
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A legal addendum modifying purchase agreement terms to account for COVID-19 related delays or disruptions in real estate transactions.
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ResidentFellow Leave Request Form
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Form for residents and fellows to request medical, parental, or caregiver leave, documenting leave details and receiving institutional approval.
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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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GPTC Employee Complaint Resolution
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A procedure establishing a uniform process for resolving employment concerns and encouraging fair communication between employees and supervisors.
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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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Century College Commencement 2022 Frequently Asked Questions
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Detailed information about Century College's 2022 graduation ceremony, including in-person and potential virtual event details.
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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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GRIEVANT INTERVIEW FORM
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A detailed form for documenting and assessing employee grievances and potential contractual disputes.
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Employee GrievanceComplaint Form
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A formal document for employees to file workplace grievances or complaints through a structured escalation process.
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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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Payroll Delivery Form
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Form for employees to select their preferred method of receiving payroll payments, including direct deposit, pay card, or Western Union transfer.
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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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Guardian Life Insurance Enrollment Form
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Insurance enrollment form for University of Massachusetts Medical School employees to select benefits and coverage options.
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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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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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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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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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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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Interview Form
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A document used to collect details about alleged harassment incidents within a school district.
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Utility Account COVID 19 Financial Hardship And Deferred Payment Agreement
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A form allowing utility customers experiencing financial hardship during the COVID-19 pandemic to defer utility payments and avoid service disconnection.
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TenantS Declaration Of Hardship During The COVID 19 Pandemic
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A legal form providing tenants protection from eviction due to financial hardship or medical risk during the COVID-19 pandemic.
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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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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 standardized form for documenting workplace safety hazards, observations, and recommended corrective actions.
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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 identifying, assessing, and reporting workplace safety hazards with risk assessment matrix.
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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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HC 0030 Retroactive Unlimited Sick Leave Request Form
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A form for eligible 9/11 rescue and recovery workers to request retroactive unlimited paid sick leave for 9/11-related illnesses.
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Hiram College Enrollment Form
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A comprehensive benefits enrollment form for Hiram College employees covering medical, dental, vision, and supplemental insurance options.
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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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HEALTHCARE ADVOCATE TOOLS LINKS PHONE NUMBERS
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Comprehensive guide for AlaskaCare employees and retirees with contact information and resources for health insurance plans and provider networks.
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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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Family Household Income Statement
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Form for verifying household income and financial assistance for Child Care services through the Ohio Department of Job & Family Services.
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