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[DOC File]Exhibit 5-3: Acceptable Forms of Verification
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Notarized statement or signed affidavit attesting to amounts paid. The owner must determine if this expense is to be considered medical or disability assistance. Child care expenses (including verification that a family member who has been relieved of child care is working, attending school, or looking for employment).
attending attestation sample

DOCTOR'S FORM LETTER
Title: DOCTOR'S FORM LETTER Author: Barbara Ward Last modified by: ALROMEO Created Date: 8/23/2007 10:20:00 PM Company: DOH Other titles: DOCTOR'S FORM LETTER
attending attestation statement

[DOC File]Hospice Care (hospic) - Medi-Cal
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The attending physician (if one exists) and the medical director or ... Attestation requirements. A hospice physician or NP who performs the encounter must attest in writing that he or she had a face-to-face encounter with the patient, including the date of the encounter. ... For example, if the patient is an emergency weekend admission, it may ...
attending attestation template

[DOC File]Advance Directives - Michigan
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No. For example, you may be in good health but still not want to be resuscitated should your heart and lungs fail. ... custody and medical treatment decisions for me if my attending physician and another physician or licensed psychologist determine I am unable to participate in medical treatment decisions. ... ATTESTATION OF WITNESSES. The ...
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[DOCX File]Program Change Notification Requirements
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Program Change Notification Requirements. At any time when a change to one of the following is made, IMMEDIATE notification of the change is required. Use the annual attestation form below to submit notification to: academic.affairs@ahima.org. If such notification is not received within 30 days of occurrence, program approval may be suspended.
document attestation example

[DOC File]Sample Letter Re: Hospital Privileges and Competency ...
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Facility Name. Facility Address. Regarding applicant: John Doe, M.D. Specialty: General Surgery. Dear Medical Services Professional: We have received a request from the above-named provider to provide services in the area of radiological interpretations.
example of an attestation statement

[DOCX File]ocfs.ny.gov
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Please submit your enrollment roster as of March 1, 2020, labeled with the classroom/group number and submitted with this application (see example below). Attendance sheets from March 1, 2020, will be accepted.
physician attestation example

[DOCX File]ocfs.ny.gov
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This application is for two separate grants available through New York State from the federal CARES Act related to the COVID-19 pandemic. One grant opportunity is a one-time reopening/restructuring materials, activities, and supplies grant to assist reopening and expansion of capacity in child care programs to support a more socially distant model.
attending physician attestation example

[DOC File]Sample Physician Letter to Social Security
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Here is the example I gave the SS lawyers to present to the judges: A sighted person putting on his shoes sits on the bed, quickly glances about the room, finds his shoes and puts them on. A blind person has learned to always put his shoes next to the leg of the bed and quickly finds them by feel and puts them on. The person with BEB in a good ...
attending attestation sample

[DOC File]Training Acknowledgment Form - Labor Law Center
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[Company Name] [Company Header, if desired] Training Module/Class: Date of Attendance: I confirm that I attended the training class listed above. I listened, read, and understood the training, and I understand that as an employee, it is my responsibility to abide by [Company Name] policy and procedures, in accordance with the training.
attending attestation statement

Attending attestation example