Tampa general hospital portal
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
https://info.5y1.org/tampa-general-hospital-portal_1_6955d1.html
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,
[PDF File]Certification of Health Care Provider for Employee’s ...
https://info.5y1.org/tampa-general-hospital-portal_1_9679a0.html
Page 1 Form WH-380-E Revised May 2015 Certification of Health Care Provider for U.S. Department of Labor Employee’s Serious Health Condition Wage and Hour Division (Family and Medical Leave Act)
[PDF File]DD Form 1172-2, Application for Identification Card/DEERS ...
https://info.5y1.org/tampa-general-hospital-portal_1_743448.html
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[PDF File]Application for Social Security Card
https://info.5y1.org/tampa-general-hospital-portal_1_2f3b83.html
Application for a Social Security Card. ... Certificate of Naturalization, employee identity card, certified copy of medical record (clinic, doctor or hospital), health insurance card, Medicaid card, or school identity card/record. For young children, we may accept medical ... GENERAL: Items on the form are self-explanatory or are discussed ...
[PDF File]Master Agreement between the Department of Veteran Affairs ...
https://info.5y1.org/tampa-general-hospital-portal_1_f02531.html
Master Agreement between the Department of Veterans Affairs and the American Federation of Government Employees 2011 VA Pamphlet 05-68 MARCH 2011 P70450
[PDF File]VA Form 10-10EZR
https://info.5y1.org/tampa-general-hospital-portal_1_2cef92.html
General Information: 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]Declaration for Federal Employment* OMB No. 3206-0182
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Declaration for Federal Employment* (*This form may also be used to assess fitness for federal contract employment) Form Approved: OMB No. 3206-0182 U.S. Office of Personnel Management. 5 U.S.C. 1302, 3301, 3304, 3328 & 8716
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
https://info.5y1.org/tampa-general-hospital-portal_1_8f9cb8.html
Limited to full scope inpatient hospital and inpatient mental health services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility. F4 Restricted No ACIP Title (XIX/Title XXI). ... Aid Codes Master Chart (aid codes) ...
[PDF File]Application For Supplemental Security Income (SSI)
https://info.5y1.org/tampa-general-hospital-portal_1_fff18e.html
APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (SSI) Form Approved OMB No. 0960-0229. Page 1. TEL Note: Social Security Administration staff or others who help people apply for SSI will fill out this form for you. I am/We are applying for Supplemental Security Income and any federally administered state supplementation under Title XVI of the Social
[PDF File]Practitioner and Provider Compliant and Appeal Request
https://info.5y1.org/tampa-general-hospital-portal_1_3d260f.html
Practitioner and Provider Complaint and Appeal Request NOTE: Completion of this form is mandatory. To obtain a review submit this form as well as information that …
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