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[PDF File]WITHDRAWAL STATE OF CONNECTICUT SUPERIOR ... - …
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STATE OF CONNECTICUT . SUPERIOR COURT. www.jud.ct.gov. For Court Use Only (WDCOMP) (WDINTCO) (WDTHPC) (WAPPCOM) (WOAAP) Name of case (First-named Plaintiff vs. First-named Defendant) Address of court (Number, street, town and zip code) Judicial District. Housing Session. Party Party Party Party
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State of Connecticut Emergency Room Copayment Waiver ...
State of Connecticut Emergency Room Copayment Waiver Request CO-1315 REV 5/2019 This form must be completed by an employee seeking a waiver of an Emergency Room Copayment of $250*. Submit this form to your Carrier. You must provide all requested information. Incomplete forms will be returned. Your waiver request will be processed within 60 days.
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[PDF File]State of Connecticut Emergency Room Copayment Waiver ...
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State of Connecticut Emergency Room Copayment Waiver Request CO-1315 REV 10/2017 This form must be completed by an employee seeking a waiver of an Emergency Room Copayment of $250*. Submit this form to your Carrier. You must provide all requested information. Incomplete forms will be returned. Your waiver request will be processed within 60 days.
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[PDF File]SECTION 1 (PLEASE PRINT OR TYPE) - State of Connecticut ...
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AT-5 Rev 9/19 Form 1 of 2 Page 1 of 2 OFFICE OF APPRENTICESHIP TRAINING Connecticut Department of Labor Apprentice Registration Agreement SECTION 1 (PLEASE PRINT OR TYPE) Apprentice Name
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[PDF File]State of Connecticut Department of Education Health ...
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State law requires complete primary immunizations and a health assessment by a legally qualified practitioner of medicine, an advanced practice registered nurse or registered nurse, a physician assistant or the school medical advisor prior to school entrance in Connecticut (C.G.S. Secs. 10 …
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[PDF File]State of Connecticut Department of Education Health ...
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State of Connecticut Department of Education Health Assessment Record To Parent or Guardian: In order to provide the best educational experience, school personnel must understand your child’s health needs. This form requests information from you (Part I) which will …
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[PDF File]IMMUNIZATION REQUIREMENTS FOR ENROLLED STUDENTS …
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STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH IMMUNIZATION REQUIREMENTS FOR ENROLLED STUDENTS IN CONNECTICUT SCHOOLS 2019-2020 SCHOOL YEAR Revised 1/3//2019 PRESCHOOL DTaP: 4 doses (by 18 months for programs with children 18 months of age) Polio: 3 doses (by 18 months for programs with children 18 months of age)
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State of Connecticut Department of Education Health ...
State of Connecticut Department of Education Health Assessment Record To Parent or Guardian: In order to provide the best educat ional experience, school personnel must understand your child’ s health needs. This form requests information from you (Part 1) which will also be helpful to the health care provider when he or she
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[PDF File]Authorization for the Administration of ...
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I hereby request that the above ordered medication be administered by school, child care and youth camp personnel and I give permission for the exchange of information between the prescriber and the school nurse, child care nurse or camp nurse necessary …
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[PDF File]Guardianship in Connecticut
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Guardianship - 4 See - Section 4: Standby Guardians (page 17) Coguardians: “If any minor has no parent or guardian of his or her person, the Probate Court for the district in which the minor resides, is domiciled or is located at the time of the filing of the petition may, on its own motion, appoint a
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State of ct school forms