AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES
|
|
- Marta Martin Lucero
- hace 8 años
- Vistas:
Transcripción
1 AGENCY POLICY: REVIEW OF NOTICE OF PRIVACY PRACTICES SCOPE OF POLICY This policy applies to all agency staff members. Agency staff members include all employees, trainees, volunteers, consultants, students, contractors and subcontractors at the agency. STATEMENT OF POLICY The Arc of Monroe County shall review its Notice of Privacy Practices with people served no later than the date when they are formally enrolled into a program or service. We are required to verify that the person served or personal representative have received the notice. Copies of the current notice shall be maintained and readily available at all programs, sites and locations. If/when there is a material revision to the notice, a copy of the notice will be available for people at non-residential sites and they will be notified that it has been revised within 60 days of the revision. The Arc s notice of privacy practices shall be given to staff consistent with the policy on Employee Health Records. Please cross reference that policy. IMPLEMENTATION OF POLICY Program management is required to ensure the review with people served or their personal representative of the notice of privacy practices at the time of the enrollment. The Confirmation of receipt of notice of privacy practices should be filled out at this time (see attached). If signed, a copy must be maintained in the person s designated record set. If the person served or their personal representative choose not to sign the confirmation or sign it and fail to return it, management should clearly document in the person s designated record set when the notice was given to the person or their personal representative. The privacy officer will notify Arc management of any material change in the notice and will inform them when new notices need to be made available to people serve and when they need to be notified of the change. VIOLATIONS The agency s Privacy Officer has general responsibility for implementation of this policy. Members of our medical staff and agency staff who violate this policy will be subject to disciplinary action up to and including termination of employment or contract with The Arc of Monroe County. Anyone who knows or has reason to believe that another person has violated this policy should report the matter promptly to his or her supervisor or the
2 agency s Privacy Officer. All reported matters will be investigated, and, where appropriate, steps will be taken to remedy the situation. Where possible, The Arc of Monroe County will make every effort to handle the reported matter confidentially. Any attempt to retaliate against a person for reporting a violation of this policy will itself be considered a violation of this policy that may result in disciplinary action up to and including termination of employment or contract with The Arc of Monroe County. QUESTIONS If you have questions about this policy, please contact your department supervisor or the agency s Privacy Officer. It is important that all questions be resolved as soon as possible to ensure protected health information is used and disclosed appropriately. Effective date: 4/1/03 Revised: 8/04 Revised: 9/17/08 8/5/15
3 Confirmation of Receipt of Notice of Privacy Practices The Arc of Monroe County, NYSARC, Inc. Name of person served: Date: Program/Service: By signing below, I acknowledge that: I have reviewed The Arc of Monroe County s Notice of Privacy Practices I have had clarified any part of the Notice which was unclear or about which I had questions I have been informed of my right to request restrictions on the uses and disclosures of my protected health information for emergency situations or for the carrying out of treatment, payment, or operations, as proposed by The Arc The Arc is not obligated to agree to any restrictions on uses or disclosures that I request Person served Guardian* Please note: By signing the as guardian, I verify that I am the person s court-appointed legal guardian. If there is a legal guardian, no further signatures are required. Advocate* As advocate, please check the box which reflects your relationship with the person served: I am an involved Parent Spouse Adult child Adult sibling
4 Other: Please note: By signing as the person s advocate, I verify that I am acting on his/her behalf in regards to this notice and the specific privacy practices noted therein. Recibo del Aviso de Practicas Privadas The Arc of Monroe County, NYSARC, Inc. Nombre del cliente: Fecha: Programa/Servicio: Al firmar este documento, reconozco que: - He revisado el Aviso de Practicas Pivadas de la agencia. - He sido explicado sobre algunas partes del Aviso que no entendia y de las cuales tenia preguntas. - He sido informado de mi derecho a restringir el uso o divulgacion acerca de mi salud en caso de situaciones de emergencia, o para llevar a cabo un tratamiento, pagos, o una operacion; recomendada por The Arc. - The Arc no esta obligada a aceptar ninguna restriccion en el uso o divulgacion que yo solicite. Cliente: Guardian* Nota: Firmando como guardian, certifico que yo soy el guardian legal del cliente, designado por la Corte. Si hay un guardian legal, no es necesario mas firmas. Promotor* Como promotor, por favor marque el espacio que refleje su relacion con el cliente. Mi relacion es: Padres Esposo(a) Hijo(a) adulto Hermano(a) adulto Otro: Nota: Firmando como promotor del cliente, verifico que estoy actuando en su nombre en relacion a este Aviso y a las especificas practicas privadas anotadas en el.
5 * Una de estas firmas es requerida por el grupo de tratamiento, si el individuo no tiene la capacidad de endender este Aviso.
Lump Sum Final Check Contribution to Deferred Compensation
Memo To: ERF Members The Employees Retirement Fund has been asked by Deferred Compensation to provide everyone that has signed up to retire with the attached information. Please read the information from
Más detallesPRINTING INSTRUCTIONS
PRINTING INSTRUCTIONS 1. Print the Petition form on 8½ X 11inch paper. 2. The second page (instructions for circulator) must be copied on the reverse side of the petition Instructions to print the PDF
Más detallesMigrant. Learners Today LEADERS Tomorrow!
Migrant Learners Today LEADERS Tomorrow! 2014 Migrant Summer Program Language Enrichment for English Language Learners Through Science Themes Students will enhance English language acquisition through
Más detallesTITLE VI COMPLAINT FORM
[CITY SEAL/EMBLEM] The Capital City of the Palm Beaches TITLE VI COMPLAINT FORM Title VI of the 1964 Civil Rights Act requires that "No person in the United States shall, on the ground of race, color or
Más detallesStudent Violence, Bullying, Intimidation, Harassment
Case 4:74-cv-00090-DCB Document 1690-6 Filed 10/01/14 Page 159 of 229 Student Violence, Bullying, Intimidation, Harassment COMPLAINT FORM (To be filed with any School District employee who will forward
Más detallesIdentity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary)
Identity and Statement of Educational Purpose (To Be Signed in the Presence of a Notary) If the student is unable to appear in person at (Name of Postsecondary Educational Institution) to verify his or
Más detalleswww.deltadentalins.com/language_survey.html
Survey Code: Survey 1 February 6, 2008 Dear Delta Dental Enrollee: Recent changes in California law will require that all health care plans provide language assistance to their plan enrollees beginning
Más detallesNews Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms
I M P O R T A N T News Flash! A FAX Publication for Providers of Sharp Health Plan To: From: Primary & Specialty Care Providers Sharp Health Plan Date: February 17, 2012 Subject: Member Grievance Forms
Más detallesAUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION
FORM 16-1 AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION Completion of this document authorizes the disclosure and use of health information about you. Failure to provide all information requested
Más detallesHEAD START MEDICATION ADMINISTRATION
HEAD START MEDICATION ADMINISTRATION Dear Parents/Guardians: It is the policy of Head Start to cooperate with each Head Start child's parent/guardian and his/her physician by administering and providing
Más detallesWelcome to the CU at School Savings Program!
Welcome to the CU at School Savings Program! Thank you for your interest in Yolo Federal Credit Union s CU at School savings program. This packet of information has everything you need to sign your child
Más detallesFinancial Affidavit for Child Support, DC 6:5(2) Declaración Jurada de Finanzas para Manutención de Menores, DC 6:5(2).
IN THE DISTRICT CURT F CUNTY, NEBRASKA (county where Complaint filed) EN LA CRTE DE DISTRIT DEL CNDAD DE, NEBRASKA (condado donde se entabló la Demanda), ) (your full name) (su nombre completo) ) Plaintiff,/
Más detallesWorkers Compensation Non-Subscriber Form
Workers Compensation Non-Subscriber Form Texas is unique in one very important respect: It s the only state in which employers have the choice to carry workers compensation insurance or not. There are
Más detallesOJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal.
OJO: Todos los formularios deberán llenarse en inglés. De lo contrario, no se le permitirá presentar sus documentos ante la Secretaría del Tribunal. For Clerk s Use Only (Para uso de la Secretaria solamente)
Más detallesRENT CONTROL BOARD OF THE TOWN OF WEST NEW YORK, N.J. 428-60 TH STREET WEST NEW YORK, N.J. 07093-2231 (201) 295-5290/91/92
FELIX E. ROQUE, MD MAYOR DEPT. OF PUBLIC AFFAIRS RENT CONTROL BOARD RENTAL AGREEMENT APPLICATION NAME OF ADDRESS OF LANDLORD: PROPERTY ADDRESS: APARTMENT #: 3 COPIES (1) Original rental agreement signed
Más detalles1. Sign in to the website, http://www.asisonline.org / Iniciar sesión en el sitio, http://www.asisonline.org
Steps to Download Standards & Guidelines from the ASIS International Website / Pasos para Descargar los Standards & Guidelines de la Página Web de ASIS International 1. Sign in to the website, http://www.asisonline.org
Más detallesFAMILY MEDICAL CENTRE
FAMILY MEDICAL CENTRE Patient Information Sheet / Informacion del Paciente DATE: Fecha LAST NAME: FIRST NAME / MI: Apellido Nombre / Inicial ADDRESS: APT #: CITY / STATE: ZIP: Direccion Ciudad / Estado
Más detalles\RESOURCE\ELECTION.S\PROXY.CSP
The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about
Más detallesMISSISSIPPI EMPLOYEES
1961 Diamond Springs Road Virginia Beach, VA 23455 Phone (757) 460-6308 Fax (757) 457-9345 MISSISSIPPI EMPLOYEES MANCON Employees, Included in this packet is the following information: 1. Job Insurance
Más detallesNOTICE OF ERRATA MEDICARE Y USTED 2006 October 18, 2006
CONTENTS 1) Notice of Errata 10/18/05 2) General Message for Partners 3) Action Plan for Spanish Handbook Error 4) Language for CMS Publication Mailing List 1 Where Does the Error Occur? NOTICE OF ERRATA
Más detallesBIENVENIDOS A LA OFICINA DEL DR. VICTOR LOOS. Por favor revise y llene las siguientes formas:
BIENVENIDOS A LA OFICINA DEL DR. VICTOR LOOS Por favor revise y llene las siguientes formas: Notice of Privacy of Policy (Aviso de privacidad al paciente) Leer y puede quedarse con él Informacion del Cliente
Más detallesLOS ANGELES UNIFIED SCHOOL DISTRICT OFFICE OF PERMITS AND STUDENT TRANSERS
INTER-DISTRICT PERMIT APPEALS If your inter-district permit application has been denied cancelled, or revoked, you may appeal the decision if you believe that an exception to district policy is warranted
Más detallesStudent and Adult Release Forms
Student and Adult Release Forms The following sample release forms are provided along with an explanation of the forms and your responsibility. For Tasks 3 and 4, your response will be based, in part,
Más detallesFAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner
FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner
Más detallesWe appreciate your time and patience as we work towards resolving this problem.
Please download the attached Barking Dog Incident Log Take the time to fill out the log completely, When at least seven (7) days of habitual barking are documented, the log should be returned to Animal
Más detallesSchool Food and Nutrition Services - 703.791.7314 Facilities Management Services - 703.791.7221
SUPPORT SERVICES To: All Principals All Food Service Managers Approved by: Dave Cline Contact Person: Serena Suthers SUPPORT SERVICES Spring Break Refrigerator/Freezer Checks This notice remains in effect
Más detallesFor more information regarding these forms please go to the Texas Department of Insurance website http://www.tdi.state.tx.us/forms/form20employer.
CAPROCK Claims Management, LLC ROCK SOLID PERFORMANCE AND RESULTS PO Box 743427 Dallas, TX 75374 (888) 812-3577 Fax (972) 934-3091 IMPORTANT NOTICE FOR REQUIRED FILING FORMS DWC FORM-5 & DWC FORM-7 Caprock
Más detallesI am the parent or legal guardian of.
EXHIBIT Descriptive Code: IFCB-R/E (2) FIELD TRIPS AND EXCURSIONS Date: March 9, 2006 Clarke County School District Student Travel Authorization and Teacher ation Form To SCHOOL: I am the parent or legal
Más detallesAll written implementation materials are provided in both English and Spanish. The Employee MPN Information packet includes the following documents:
Dear Employer, Your company has elected to participate in the Medical Provider Network (MPN) Program, which is the MPN utilized by Hanover Insurance Company for workers compensation. This letter is designed
Más detallesCARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES
CARTA INFORMACIONAL AL LITIGANTE LINEA DE AYUDA HOJA DE CALCULOS DE MANUTENCION DE MENORES CHILD SUPPORT WORKSHEET HELPLINE INFORMATIONAL LETTER TO LITIGANT Estimado Pro Se Litigante, Dear Pro Se Litigant,
Más detallesINFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN
INFORMACIÓN PARA ABRIR UNA GUARDERÍA DE NIÑOS PARA FAMILIAS O GRUPOS EN LA CIUDAD DE ALLENTOWN Informacion importante de saber: Una guarderia de niños para familias consite de un niño hasta 6 niños. Una
Más detallesTITLE VI COMPLAINT FORM
TITLE VI COMPLAINT FORM Before filling out this form, please read the Arcata and Mad River Transit System Title VI Complaint Procedures located on our website or by visiting our office. The following information
Más detallesAs the 2013-14 school year comes to a close, Camden City School District is excited to get summer programming underway!
June 2014 Dear Parents and Guardians: As the 2013-14 school year comes to a close, Camden City School District is excited to get summer programming underway! The District Summer School Program will operate
Más detallesCreating your Single Sign-On Account for the PowerSchool Parent Portal
Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to
Más detallesTitle VI Complaint Procedures
Title VI Complaint Procedures As a recipient of federal dollars, HELP of Ojai, Inc. is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that services and benefits are provided
Más detallesPB #11-111-OPE. Attachment: Please use Print on M-687r Referral to Treatment Program (Rev. 11/30/11) (Rev. 11/30/11)
FAMILY INDEPENDENCE ADMINISTRATION Matthew Brune, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Stephen Fisher, Assistant Deputy Commissioner Office
Más detallesThe Home Language Survey (HLS) and Identification of Students
The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) is the document used to determine a student that speaks a language other than English. Identification of a language
Más detallesDown Payment Assistance Application Packet
Down Payment Assistance Application Packet Please assure that all needed items are attached and complete. Please note that your application will not be considered until all documents are received. 1. Down
Más detallesODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights. ODJFS Bureau of Civil Rights
ODJFS Bureau of Civil Rights I NEED AN INTERPRETER, PLEASE. Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of national origin. If you do not speak English well, social services,
Más detallesMANUAL EASYCHAIR. A) Ingresar su nombre de usuario y password, si ya tiene una cuenta registrada Ó
MANUAL EASYCHAIR La URL para enviar su propuesta a la convocatoria es: https://easychair.org/conferences/?conf=genconciencia2015 Donde aparece la siguiente pantalla: Se encuentran dos opciones: A) Ingresar
Más detallesPassaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470
Note: Instructions in Spanish immediately follow instructions in English (Instrucciones en español inmediatamente siguen las instrucciónes en Inglés) Passaic County Technical Institute 45 Reinhardt Road
Más detallesIMPORTANT INFORMATION
Checklist IMPORTANT INFORMATION and REQUIRED FORMS Parents should review and be familiar with the following information. The relevant forms must be printed, completed and returned to the school by Friday,
Más detallesRegistro de Semilla y Material de Plantación
Registro de Semilla y Material de Plantación Este registro es para documentar la semilla y material de plantación que usa, y su estatus. Mantenga las facturas y otra documentación pertinente con sus registros.
Más detallesWorkplace Safety - The Role of Staff
The Occupational Safety and Health Act (OSHA) The Act requires each worker to comply with occupational safety and health standards, as well as all rules, regulations, and orders issued under the Act that
Más detallesChild Care Assistance Program Búsqueda de Trabajo
Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.
Más detallesEmployee s Injury Report / Informe de lesión de empleado
Claims Administrative Services Phone: 800-765-2412 Fax: 903-509-1888 501 Shelley Drive Claims Administrative Services, Inc. Tyler, Texas 75701 Our reputation for excellence is no accident. / Nuestro prestigio
Más detallesSetting Up an Apple ID for your Student
Setting Up an Apple ID for your Student You will receive an email from Apple with the subject heading of AppleID for Students Parent/Guardian Information Open the email. Look for two important items in
Más detallesDEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS
DEPARTAMENTO ESTATAL DE SERVICIOS DE SALUD DE TEXAS DAVID L. LAKEY, M.D. DIRECTOR P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY (teletipo): 1-800-735-2989 www.dshs.state.tx.us 1 de marzo,
Más detalles~~,llj EFFECTIVE FOR SERVICE O!~ OCT 1 1531 EILEEN ACRES SERVICE CORPORATION ORIGINAL FORM NO.5. Page 1 of 5 TITLE OF FORNI ATTACHMENT TO FINAL NOTICE
-----------------~ EILEEN ACRES SERVICE CORPORATION ORIGINAL FORM NO.5 TITLE OF FORNI ATTACHMENT TO FINAL NOTICE Page 1 of 5 EFFECTIVE FOR SERVICE O!~ OCT 1 1531 BY Co:" ~~, e2-=o;...::~..;;..c> AfJPFlt)VED
Más detallesFor Parents and Caregivers
Who Qualifies How to Enroll WHO QUALIFIES FOR WIC: HOW TO ENROLL IN WIC: You must Bring the infant or child to the WIC office to complete initial enrollment. If the infant or child can t be there because
Más detallesACKNOWLEDGMENT OF RECEIPT AND UNDERSTANDING (For Lay / Religious Employees)
(For Lay / Religious Employees) (www.dioceseofbmt.org/safeenvironment). I am responsible for seeing that any persons under my supervision (e.g. parish/mission/school employees and volunteers) also read
Más detallesALERT. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and:
ALERT Customers who received a premium tax credit in 2014 and are preparing to renew his/her health coverage for 2016 are required to have filed his/her 2014 taxes in order to continue receiving his/her
Más detallesSteps to Understand Your Child s Behavior. Customizing the Flyer
Steps to Understand Your Child s Behavior Customizing the Flyer Hello! Here is the PDF Form Template for use in advertising Steps to Understanding Your Child s Behavior (HDS Behavior Level 1B). Because
Más detallesTitle VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Office of Civil Rights
Title VI Complaint Form Horizon Cross Cultural Center (HORIZON) (formerly St. Anselm s Cross-Cultural Community Center) Title VI of the Civil Rights Act of 1964 provides that no person in the United States
Más detallesChapter Six. Sanitary and Phytosanitary Measures
Chapter Six Sanitary and Phytosanitary Measures Objectives The objectives of this Chapter are to protect human, animal, or plant life or health in the Parties territories, enhance the Parties implementation
Más detallesSummary: Revised PacifiCare member grievance forms and the responsibilities of the provider group
, 2009 Communication 09 xxxx Suggested Distribution: Administrator Medical Director Health Plan Coordinator Quality Management Utilization Management Operations Office Chief Financial Officer Product Type:
Más detallesHelp Stop Medicare Fraud
Help Stop Medicare Fraud An important message from Medicare for people in Miami-Dade, Broward and Palm Beach Counties Fraud costs the Medicare Program billions of dollars every year. Fraud can happen when
Más detallesDaly Elementary. Family Back to School Questionnaire
Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire
Más detallesSUNRISE PEDIATRICS SANJAY KANDOTH, MD 3061 S MARYLAND PARKWAY SUITE #101 LAS VEGAS, NV 89109 PH # 702-254-KIDS (5437) FAX # 702-254-7354
SUNRISE PEDIATRICS SANJAY KANDOTH, MD 3061 S MARYLAND PARKWAY SUITE #101 LAS VEGAS, NV 89109 PH # 702-254-KIDS (5437) FAX # 702-254-7354 NEW PATIENT REGISTRATION FORM FORMA DE REGISTRACION PARA PACIENTES
Más detallesSchool Preference through the Infinite Campus Parent Portal
School Preference through the Infinite Campus Parent Portal Welcome New and Returning Families! Enrollment for new families or families returning to RUSD after being gone longer than one year is easy.
Más detallesCHANGE OF FAMILY COMPOSITION PACKET - REMOVE MEMBER
818 S. FLORES ST. SAN ANTONIO, TEXAS 78204 www.saha.org CHANGE OF FAMILY COMPOSITION PACKET - REMOVE MEMBER Participant: In an effort to ensure you/your family is served in a timely manner, we are requesting
Más detallesAffordable Care Act Informative Sessions and Open Enrollment Event
2600 Cedar Ave., P.O. Box 2337, Laredo, TX 78044 Hector F. Gonzalez, M.D., M.P.H Tel. (956) 795-4901 Fax. (956) 726-2632 Director of Health News Release. Date: February 9, 2015 FOR IMMEDIATE RELEASE To:
Más detallesGoodwill Serving the People of Southern Los Angeles County. Title VI Notice to the Public
Title VI Notice to the Public Notifying the Public of Rights Under Title VI (Goodwill SOLAC) operates its programs and services without regard to race, color, and national origin in accordance with Title
Más detallesSi tiene cualquier pregunta llame a su trabajadora de CCAP al número de teléfono indicado abajo. Boulder County Child Care Assistance Program
Child Care Assistance Program Búsqueda de Trabajo Usted ha pedido cuidado para sus niños mientras busca trabajo a través del programa de CCAP. Este programa ofrece un total de 30 días mientras busca trabajo.
Más detallesThank you. US English US Spanish. Australia-English Canada-English Ireland-English New Zealand-English Taiwan-English United Kingdom-English
Dear Healthcare Provider, Included in this PDF are recruitment brochures in several languages to be used in MM Bone study (Protocol No.: 20090482). Kindly note these brochures have been updated according
Más detallesIRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR
IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid
Más detallesGuide to Health Insurance Part II: How to access your benefits and services.
Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find
Más detallesPROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO
CENTRO DE AUTOSERVICIO PROCEDIMIENTOS: QUÉ HACER CON EL PEDIMENTO UNA VEZ QUE SE HA COMPLETADO PASO 1: COPIAS Y SOBRES. Haga tres (3) copias de las páginas siguientes del pedimento; Haga dos (2) copias
Más detallesCanutillo Middle School 7311 Bosque, P.O. Box 100 Canutillo, Texas 79835 (915) 877-7900 Fax (915) 877-7919
Mark Paz August 24, 2015 Dear Parents/Legal Guardian, I would like to start by thanking each and every single one of you for the tremendous help and support we have been receiving. Thank You! Next school
Más detallesLearning Masters. Early: Force and Motion
Learning Masters Early: Force and Motion WhatILearned What important things did you learn in this theme? I learned that I learned that I learned that 22 Force and Motion Learning Masters How I Learned
Más detallesINSTRUCTIONS FOR PREPARING THE RESEARCH AUTHORIZATION FORM:
550 First Ave. Building #VET 10 West NY, NY 10016 Phone: 212.263.4110 Fax: 212.263.4147 INSTRUCTIONS FOR PREPARING THE RESEARCH AUTHORIZATION FORM: Please note that this shaded gray section is for instruction
Más detallesExceptional Children s Foundation Title VI Notice to the Public
Title VI Notice to the Public Notifying the Public of Rights Under Title VI Exceptional Children s Foundation The Exceptional Children s Foundation (ECF) operates its programs and services without regard
Más detallesBecoming Independent Title VI Program
Title VI Complaint Procedures As a recipient of federal fund, Becoming Independent is required to comply with Title VI of the Civil Rights Act of 1964 and ensure that program and services are provided
Más detallesANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN DEL PUPILO/PERSONA INCAPACITADA/INHÁBIL
Nebraska State Court Form REQUIRED Formulario del Tribunal del Estado de Nebraska REQUERIDO ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD/INCAPACITATED PERSON INFORME ANUAL DEL TUTOR SOBRE LA CONDICIÓN
Más detalles2014 15 Student Eligibility Verification Advanced Placement/International Baccalaureate Test Fee Program
2014 15 Student Eligibility Verification Advanced Placement (AP) and/or International Baccalaureate (IB) Exams þ AP Exam IB Exam AP and IB Exams I. Student Information Last Name First Name MI Grade High
Más detallesHOMEWORK HELP PROGRAM STUDENT REQUIREMENTS STUDENT GUIDELINES
HOMEWORK HELP PROGRAM This program is a cooperative learning experience shared between high school and elementary school students in the East Ramapo Central School District. It is designed to match Elementary
Más detallesJanssen Prescription Assistance. www.janssenprescriptionassistance.com
Janssen Prescription Assistance www.janssenprescriptionassistance.com Janssen Prescription Assistance What is Prescription Assistance? Prescription assistance programs provide financial help to people
Más detallesNombre de la persona completando esta forma
mbre de Paciente mbre de la persona completando esta forma Fecha Relación del paciente / / Sexo Masculino Raza Numero de Seguro Social Fecha de Nacimiento Femenino / / / / POR FAVOR LISTE TODA LA GENTE
Más detallesSentry Insurance Group 1800 North Point Drive, Stevens Point, WI
Sentry Insurance Group 1800 North Point Drive, Stevens Point, WI 54481 1-800-739-3344 WC-80-10-0001 (Ed. 7/06) 10-06 Sentry Insurance Group 1800 North Point Drive, Stevens Point, WI 54481 1-800-739-3344
Más detallesMore child support paid + more passed
Child Support and W-2 are working together to better serve Wisconsin families. More child support is paid when families understand the rules. Recent child support policy changes are giving more money back
Más detallesEL PASO ELECTRIC COMPANY THIRD REVISED SAMPLE FORM NO. 22 CANCELLING SECOND REVISED SAMPLE FORM NO. 22
'FILED IN OFFICE OF WMPUBLIC REG. COMM. EL PASO ELECTRIC COMPANY JAN 17 lu14 THIRD REVISED SAMPLE FORM NO. 22 CANCELLING SECOND REVISED SAMPLE FORM NO. 22 NOTIFY FOR DELINQUENT AMOUNT (IVR OUTBOUND CALL
Más detallesAre you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts?
Albany Housing Authority RESIDENT COMMISSIONER ELECTION Are you interested in helping to GOVERN the Authority, DEVELOP current and future programs, and APPROVE contracts? RUN FOR RESIDENT COMMISSIONER
Más detallesTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TEXAS DEPARTMENT OF STATE HEALTH SERVICES DAVID L. LAKEY, M.D. COMMISSIONER P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY: 1-800-735-2989 www.dshs.state.tx.us August 15, 2013 Dear Birthing
Más detallesNOTICE REQUIRED BY DELAWARE LAW: TAKE ACTION TO SAVE YOUR HOME FROM FORECLOSURE
DTA.ID00090 DTA.ID00091 DTA.ID00092 DTA.ID00093, DTA.ID00094 DTA.ID00095 DTA.ID00096 DTA.ID00097 DTA.ID00098 DTA.ID00099 DTA.ID00100, DTA.ID00101 DTA.ID00102 DTA.ID00103 Notice of Intent to Foreclose (Delaware)
Más detallesAction Required by September 30, 2018 in order to Participate as a Provider in the Puerto Rico Medicaid Government Health Plan Program
CIRCULAR LETTER #M1807134 September 15, 2018 Action Required by September 30, 2018 in order to Participate as a Provider in the Puerto Rico Medicaid Government Health Plan Program Dear Provider, Greetings
Más detallesThe 10 Building Blocks of Primary Care
The 10 Building Blocks of Primary Care My Action Plan Background and Description The Action Plan is a tool used to engage patients in behavior-change discussion with a clinician or health coach. Using
Más detallesHIV SNP Marketing Rules for Providers
HIV SNP Marketing Rules for Providers The requirements are: The HIV SNPs in New York City are contracted with the New York City Department of Health and Mental Hygiene (DOHMH), and are subject to contractual
Más detallesSIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA
SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA ELABORAR LA POLITICA AMBIENTAL PDF File: Siguiendo
Más detallesTEESP: Technology Enhanced Elementary Spanish Program Lesson Planner. Title: Qué pasa con su corazón?
: Technology Enhanced Elementary Spanish Program Lesson Plan #: 60 Story #: 2 Level 6 Resources used: Title: Qué pasa con su corazón? Pages/URL/etc.: Cuéntame! Pages 167-174 Objective(s) & Progress Indicator(s):
Más detallesChattanooga Motors - Solicitud de Credito
Chattanooga Motors - Solicitud de Credito Completa o llena la solicitud y regresala en persona o por fax. sotros mantenemos tus datos en confidencialidad. Completar una aplicacion para el comprador y otra
Más detallesWelcome Savers! 1. Fill out application form if you re not already a Yolo FCU member.
Welcome Savers! Yolo Federal Credit Union and Montgomery Elementary School have teamed up again this year to bring you our school saving program! It s easy to participate... 1. Fill out application form
Más detallesCHANGE OF HOUSEHOLD COMPOSITION PACKET INSTRUCTIONS TO REMOVE A MEMBER
CHANGE OF HOUSEHOLD COMPOSITION PACKET INSTRUCTIONS TO Participant: REMOVE A MEMBER In an effort to ensure you and your household are served in a timely manner, we are requesting that you completely fill
Más detallesEl Abecedario Financiero
El Abecedario Financiero Unidad 4 National PASS Center 2013 Lección 5 Préstamos Vocabulario: préstamo riesgocrediticio interés obligadosolidario A lgunavezpidesdineroprestado? Dóndepuedespedirdinero prestado?
Más detallesRegistro de Entidad de Intermediación de Medicamentos (broker)/ Registration as a Broker of Medicinal Products
Registro de Entidad de Intermediación de Medicamentos (broker)/ Registration as a Broker of Medicinal Products En caso de nuevo registro como Entidad de Intermediación (broker), por favor continue abajo
Más detallesEste proyecto tiene como finalidad la creación de una aplicación para la gestión y explotación de los teléfonos de los empleados de una gran compañía.
SISTEMA DE GESTIÓN DE MÓVILES Autor: Holgado Oca, Luis Miguel. Director: Mañueco, MªLuisa. Entidad Colaboradora: Eli & Lilly Company. RESUMEN DEL PROYECTO Este proyecto tiene como finalidad la creación
Más detallesCal Grant GPA Electronic Submission and Opt-out Notification As of 10.13.15
12338 McCourtney Road Grass Valley, CA 95949 Phone: 530-272-4008 Fax: 530-272-4009 www.johnmuircs.com Cal Grant GPA Electronic Submission and Opt-out Notification As of 10.13.15 Assembly Bill 2160, commonly
Más detallesI understand that I must request that this waiver be reconsidered annually, each school year. Parent/Guardian Signature: Date:
Page 1 of 7 PARENTAL EXCEPTION WAIVER EDUCATION CODE 311(a): Children who know English (Exhibit 1) Name: School: Grade: Date of Birth: Language Designation: My child possesses good English language skills
Más detallesSistema basado en firma digital para enviar datos por Internet de forma segura mediante un navegador.
Sistema basado en firma digital para enviar datos por Internet de forma segura mediante un navegador. Autor: David de la Fuente González Directores: Rafael Palacios, Javier Jarauta. Este proyecto consiste
Más detallesCómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP
Cómo comprar en la tienda en línea de UDP y cómo inscribirse a los módulos UDP Sistema de registro y pago Este sistema está dividido en dos etapas diferentes*. Por favor, haga clic en la liga de la etapa
Más detallesEmployer Employer Address Phone. Phone: Home Work Cell
PATIENT REGISTRATION Last Name First Name MI Date of Birth Age Social Security # Gender Marital Status Address Street Apt# City State Zip Phone: Home Work Cell E-Mail Occupation Retired: Yes No Employer
Más detalles