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[DOC File]Sample Memorandum of Understanding (MS Word)
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A statement binding each member of the group to every statement and assurance made in the application. The following is a sample MOU that illustrates the terms that group applicants might wish to include in their agreement. Applicants are free to use their own binding agreement or to modify this sample to reflect the terms of their own agreement.
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[DOC File]SAMPLE MONTHLY FINANCIAL REPORT - Connecticut
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Provided below is a description and instructions related to the following Sample Monthly Financial Reports: Option 1. Sample Report A: Basic Reporting System. This option involves is a shorter, less detailed report that may be appropriate for smaller local governments and other local governments not in need of the greater level of detail ...
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[DOC File]SAMPLE FINANCIAL POLICY SHEET
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Any balance due or non covered services is your responsibility and is due upon receipt of a statement from our office. MINOR PATIENTS. For all services rendered to minor patients, the adult accompanying the patient is responsible for payment. I have read and understand the financial policy of the practice and I agree to be bound by its terms.
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[DOC File]Model Cost Policy Statement (MSWord)
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sample – statement of employee fringe benefits. july 1, 19xx to june 30, 19xx. method a method b. annual leave earned $ 50,384. sick leave taken 25,269. holidays 50,384. sub-total release time $ 126,037. fica $ 100,245 $ 100,242. state unemployment compensation 17,040 17,040
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[DOCX File]Sample Hospital Risk Assessment Recommendations
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Mission Statement [Enter organization’s mission] Purpose. The purpose of the risk management program is to protect patients, staff members and visitors from inadvertent injury. The program is also designed to protect the organization’s financial assets and intangibles, such as reputation and standing in the community.
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[DOC File]Sample Performance Improvement Plan Template
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Performance Improvement Plan (PIP) Confidential. Name: Position: Date: Department: The purpose of this Performance Improvement Plan (PIP) is to define performance deficiencies, clarify performance expectations, and allow you the opportunity to demonstrate your ability to meet the performance expectations outlined below.
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[DOC File]Internal Audit Plan Template
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Identify the type of Internal Audit being completed. (e.g., financial, performance, operational) 2.2 Internal Audit Subject. Identify the subject area and/or organization to …
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[DOC File]Operations Manual Template - HUD
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MANAGEMENT CERTIFICATION - Please check the appropriate statement. _____ The document is accepted. _____ The document is accepted pending the changes noted. _____ The document is not accepted. We fully accept the changes as needed improvements and authorize initiation of work to proceed. Based on our authority and judgment, the continued ...
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[DOCX File]Collaborative Practice Agreement for Nurse Practitioner ...
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Collaborative Practice Agreement for Nurse Practitioner (SAMPLE) A. Purpose. The purpose of this document is to describe the scope of practice for the nurse practitioner (NP) who signs this agreement, as well as, provide written authorization by the supervising physician for the NP to initiate and provide psychiatric and medical care for the consumers of _____(agency)
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[DOCX File]Tool 11: Community Resource Guide - Agency for Healthcare ...
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A clinical/quality leader at the hospital (e.g., director of case management, population health, or quality) should identify a key contact at each Medicaid health plan who can identify the types of supports and services the plan is providing or can provide for patients at high risk of readmission.
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Sample hospital financial statement