Free medical data sets
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,
[PDF File]Certification of Health Care Provider for Family Member’s ...
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records and documents relating to medical certifications, recertifications, or medical histories of employees’ family members, created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies,
[PDF File]G-325A, Biographic Information
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The primary purpose for providing the requested information on this form is to determine eligibility of discretionary deferred action on a case-by-case basis, for certain family members of military personnel, military personnel who previously served,
[PDF File]Request for Social Security Earnings Information
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Form . SSA-7050-F4 (03-2019) Page 2 of 4. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . 1. Provide your name as it appears on your most recent Social Security card or the name of the individual whose
[PDF File]Physician's Order for Personal Care/Consumer Directed ...
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PHYSICIAN’S ORDER FOR PERSONAL CARE/CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES . INSTRUCTIONS . COMPLETE ALL ITEMS. (Attach additional sheets, if necessary). INCOMPLETE FORMS WILL BE RETURNED TO THE PHYSICIAN. INCOMPLETE OR MISSING INFORMATION MAY DELAY SERVICES TO THIS PATIENT. 1. Patient Identifying Information • …
[PDF File]Notice of Eligibility and Rights & Responsibilities ...
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Notice of Eligibility and Rights & U.S. Department of Labor Responsibilities Wage and Hour Division (Family and Medical Leave Act) _ OMB Control Number: 1235-0003. Expires: 8/31/2021. In general, to be eligible an employee must have worked for an employer for at least 12 months, meet the hours of service requirement in the 12
[PDF File]2018 Instructions for Form 6251
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incomes. The AMT sets a limit on the amount these benefits can be used to reduce total tax. Also use Form 6251 to figure your tentative minimum tax (Form 6251, line 9). You may need to know that amount to figure the tax liability limit on the credits listed under Who Must File, earlier. Figuring AMT Amounts For the AMT, certain items of income,
[PDF File]Performance Appraisal Plan Examples - USDA
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Models appropriate behavior by presenting advice and guidance in a positive and helpful manner, including appropriate options, recommendations, and results, with no more than 6-8 valid complaints.
[PDF File]Form W-9 (Rev. October 2018)
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Form W-9 (Rev. 10-2018) Page . 2 By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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Provides county-specific, full-scope medical, dental, mental health and vision benefits to children 18 years of age or younger with a modified adjusted gross income above 266 and up to and including 322 percent of the U.S. Department of Health and Human Services (HHS) poverty guidelines. ... Aid Codes Master Chart (aid codes) ...
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