Example: dental hygienist
Fax Form
Found 2 free book(s)
18-463 New Hire Reporting Methods and Instructions - Wa
www.dshs.wa.govFax reports to 800-782-0624. If you use another company's fax machine to send your report, please write your company's name and telephone number on the fax cover sheet. You may use the form provided below, W-4 forms (add the employee's date of birth and the date of hire), or an equivalent form. Mail Reporting . Mail reports to the following ...
This form may be completed online at https://hssi.tn.gov ...
www.tn.govon this form, or attached (e.g., patient cover sheet, notifiable diseases report, relevant medical records). Provide the contact information for the provider for Public Health follow-up. If the primary place of work for the provider is a private practice, provide the name, phone, and fax for that facility rather than the hospital. Patient Name: