PHYSICIAN’S REPORT FOR COMMUNITY CARE FACILITIES

IMPORTANT INFORMATION FOR PROSPECTIVE …

state of california - health and human services agency california department of social services important information for prospective providers about the

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Important Information for the In-Home …

TEMP 3001 (11/15) PAGE 1 of 7 STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES Important Information for the

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IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM …

in-home supportive services (ihss) program health care certification form note: the ihss worker may contact you for additional information or to

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STATEMENT ACKNOWLEDGING REQUIREMENT …

LIC 9108 (3/05) PAGE 2 OF 2 SIGNATURE DATE WHERE TO CALL IN AND SEND THE WRITTEN ABUSE REPORT Reports of suspected child abuse or neglect must be made to any police department or sheriff's

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LICENSE APPLICATION AND INSTRUCTIONS FOR …

LICENSE APPLICATION AND INSTRUCTIONS FOR FAMILY CHILD CARE HOMES This contains instructions needed to file an application for a Family Child Care Home license, and to gain access to

  Applications, Instructions, License, License application and instructions for

REQUEST FOR LIVE SCAN SERVICE - COMMUNITY …

guidelines for community care licensing (ccld) applicants who use a live scan site (ccld ordoj site) for fingerprinting instructions for the lic 9163

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STATE OF CALIFORNIA - HEALTH AND HUMAN …

state of california - health and human services agency california department of social services community care licensing division lic 9214 (6/16) page 2 of 2

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STATE OF CALIFORNIA – HEALTH AND HUMAN …

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES . APPLICATION FOR SOCIAL SERVICES . To the Applicant: All sections of this form must be completed.

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STATEMENT ACKNOWLEDGING REQUIREMENT …

soc 341a (3/15) statement acknowledging requirement to report suspected abuse of dependent adults and elders name position facility note: retain in employee/ volunteer file

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STATE OF CALIFORNIA – HEALTH AND HUMAN …

REPORT OF SUSPECTED DEPENDENT ADULT/ELDER FINANCIAL ABUSE FINANCIAL INSTITUTIONS ONLY GENERAL INSTRUCTIONS PURPOSE OF THE FORM This form is to be used by officers and employees of financial institutions (“mandated reporter(s)”) to report suspected

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Brief Intake – Assessment

Is the client an undocumented U.S. resident? ... MEDICAL (This section is optional in medical settings where this information is readily accessible to the case manager.) A. Primary Medical Care Provider Name: ... Release of HIV Confidential Information form Signed?

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EMERGENCY PREPAREDNESS TEMPLATE

3. Attach plans for the following staff roles in Appendix C: Staff Roles and Resident Management a. Staff communication plan b. Staff management plan c. Critical Incident Stress Management plan d. Security e. Public Information f. Emergency food and water management g. Resident relocation for both local and regional evacuations. h.

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PSSap: withdrawing your super - CSC

ave a terminal medical condition. Further evidence may be required, please call us I h on 1300 725 171 to discuss. ave changed jobs and my PSSap super account balance is $200 or less.I h ave an I h unrestricted non preserved component. m a temporary resident permanently leaving Australia (except New Zealand I a citizens).

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Vancouver General Hospital - Vancouver Coastal Health

Personal information Vancouver Coastal Health respects your privacy and recognizes the sensitivity of your health information. We take all reasonable measures to ensure that your information is treated confidentially. Our staff may need personal details from you for insurance or care purposes. VCH privacy policies meet provincial privacy ...

  Information

IMPORTANT - WCB

Hearing Information Questionnaire (form C042) – Please note that the declaration and consent page must be signed. Employer’s Information Questionnaire (form C139) ‐ This form must be completed by your current employer if you are exposed to hazardous noise in excess of 85 dBA at your current job.

  Information

Macquarie Wrap Super and Pension Withdrawal/Rollover form

Macquarie Wrap Super and Pension Withdrawal/Rollover form 3 of 4 5 Deduction Notices (for Super only) You must complete this section if you have made a personal contribution in the current or prior financial year and intend to claim or vary a