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[PDF File]PLEASE READ CAREFULLY THE FOLLOWING INFORMATION ...
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3. Please ask your patient for his/her WCB case number and the claim administrator claim (carrier case) number and show these numbers on the form. In addition, ask your patient if he/she has retained a representative. If represented, ask for the name and address of the representative.

[PDF File]Completing Colorado W-2 Wage Withholding Tax Return Instructions
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FYI publications, forms, and answers to common questions are Completing Colorado W-2 Wage Withholding Tax Return **DO=NOT=SEND** available at www.TaxColorado.com, the official Taxation Web site. Or, you may call (303) 238-7378 to speak with a representative. Account Number: List the Colorado business account number

[PDF File]Patient Health Questionnaire (PHQ-9)
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PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive

[PDF File]Health Benefits Election Form
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Health Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 Previous edition is not usable Revised November 2015 . Uses for Standard Form (SF) 2809

[PDF File]Application for Social Security Card
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IF YOU HAVE ANY QUESTIONS. If you have any questions about this form or about the evidence documents you must provide, please visit our website at www.socialsecurity.gov for additional information as well as locations of our offices and Social Security Card Centers. You may also call Social Security at 1-800-772-1213. You can also find

[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

[PDF File]Edinburgh Postnatal Depression Scale (EPDS)
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No, not very often Please complete the other questions in the same way. No, not at all In the past 7 days: 1. I have been able to laugh and see the funny side of things *6. Things have been getting on top of me As much as I always could Yes, most of the time I haven’t been able Not quite so much now to cope at all

[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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We ask for the information on Form 941 to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount of tax. Subtitle C, Employment Taxes, of the Internal Revenue Code imposes employment taxes on wages and provides for income tax withholding. Form 941 is used to determine

[PDF File]VA Form 10-10EZR
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Answer all questions. Section II - Insurance Information: Include information for all health insurance companies that cover you, this includes coverage provided through a spouse or significant other. If you have more than one health insurer, provide this information on a separate sheet of paper and attach to the application.

[PDF File]FL-150 INCOME AND EXPENSE DECLARATION
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Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) FL-150 [Rev. January 1, 2019]

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