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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]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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[PDF File]ertificate of Exemption—Personal/Religious
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hild’s Last Name: First Name: Middle Initial: irthdate (mm/dd/yyyy): ertificate of Exemption—Medical NOTIE: This form may be used to exempt a child from the requirement of vaccination when a health care practitioner has determined specific vaccination is not advisable for the child for medical reasons.
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[PDF File]CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY
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CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK . This table reflects Medicare Specialty Codes as of April 1, 2003. This table reflects Healthcare Provider Taxonomy Codes (HPTC) effective July 1, 2004. The page numbers in parentheses correspond to the taxonomy publication, version 4.1, dated July 2004.
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[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
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[PDF File]Power of Attorney - New York State Department of Taxation ...
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02900106170094 New York State Department of Taxation and Finance New York City Department of Finance Power of Attorney POA-1 (6/17) Read instructions on the back before completing this form. For estate tax matters, use Form ET-14, Estate Tax Power of Attorney. Filing Form POA-1 does not automatically revoke any previously filed powers of attorney (POAs), but may affect who receives …
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[PDF File]INSTITUTIONAL PROVIDERS CMS-855A
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medicare enrollment application . institutional providers cms-855a . see page 1 to determine if you are completing the correct application see page 3 for information on where to mail this application. see page 52 to find a list of the supporting documentation that must be submitted with this application.
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[DOC File]www.dol.gov
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(Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov. Keep your Plan informed of address changes. To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members.
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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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Illinois healthcare worker registry lookup