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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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    • [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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    • [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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    • [PDF File]Please print or type. The Application For Employment ...

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      This job application form was downloaded from Betterteam. Application For Employment. Please print or type. The application must be fully completed to be

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    • [PDF File]TINETTI BALANCE ASSESSMENT TOOL

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      TINETTI BALANCE ASSESSMENT TOOL GAIT SECTION Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Risk Indicators: Tinetti Tool Score Risk of Falls ≤18 High 19-23 Moderate ≥24 Low Date Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts = 0 No hesitancy = 1

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    • [PDF File]Vaccine Information Statement: Recombinant Zoster ...

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      With any medicine, including vaccines, there is a chance of reactions. After recombinant shingles vaccination, a person might experience: Pain, redness, soreness, or swelling at the site of the injection Headache, muscle aches, fever, shivering, fatigue In clinical trials, most people got a sore arm with mild

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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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