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[PDF File]Resident Identifier Date MINIMUM DATA SET (MDS) - Version …
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Resident Identifier Date. MINIMUM DATA SET (MDS) - Version 3.0. RESIDENT ASSESSMENT AND CARE SCREENING. Nursing Home Comprehensive (NC) Item Set. Section A. Identification Information. A0050. Type of Record. 1. Add new record. Continue to A0100, Facility Provider Numbers. 2. Modify existing record. Continue to A0100, Facility Provider Numbers. 3.
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[DOT File]DHS-0069, Foster Care Juvenile Justice Action Summary
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Foster Care/Juvenile Justice Action Summary Michigan Department of Health and Human Services Case name Case ID Child name Child person ID Worker name Organization Phone number Email Date completed Type of action (check as many as apply) Effective date Child fatality notification (complete section 1) Caseworker/organization change (complete section 2) Parent contact information change …
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[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,
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[DOCX File]Application for Kentucky Certificate of Title or Registration
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APPLICATION FOR KENTUCKY CERTIFICATE OF TITLE OR REGISTRATION. TC 96-182. 03/2019. Check the type of application desired _____ Duplicate Title Only Transfer First Time Salvage Classic : If Duplicate is checked, the original Certificate of Title is: _____ Lost Destroyed Damaged Illegible Other ... Application for Kentucky Certificate of Title or ...
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[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit …
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[DOC File]DA FORM 2062, JAN 82 - A FREE Online and Audio Army …
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For use of this form, se DA PAM 710-2-1. The Proponent agency is ODCSLOG. FROM: TO: HAND RECEIPT NUMBER. FOR ANNEX/CR ONLY END ITEM STOCK NUMBER. END ITEM DESCRIPTION
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[DOC File]Sample Schedule A Letter - Veterans Benefits Administration
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Sample Schedule A Letter from the Department of Labor’s Office of Disability and Employment Policy: Date . To Whom It May Concern: This letter serves as certification that (Veteran’s name) is a person with a severe disability that qualifies him/her for consideration under the Schedule A hiring authority.
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