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This document provides instructions for completing the ADA J515 Dental Claim Form specifically for Texas Workers' Compensation claims. It is a guide to help dental providers correctly fill out the form for reimbursement purposes.
This Form is used for resolving disputes regarding benefits in Texas. (Spanish)
This document is a Spanish form used in Texas to request an extension of the maximum medical improvement date for spinal surgery.
This form is used for reporting the locations of an employer's business(es) in the state of Texas.
This form is used for obtaining a Certificate of Accredited Assuming Insurer in Texas.
This document is a cover sheet for the Core Competency Curriculum for Administrative Rule 432-270 in Utah.
This document provides instructions for completing the VT Form LRC-147, which is used to report the rent for mobile home park lot rent, co-ops, and land trusts in Vermont. Follow these instructions to ensure accurate reporting.
This Form is used for reporting rent for mobile home park lot rent, co-ops, and land trusts in Vermont.
This Form is used for landlords in Vermont to obtain a landlord certificate. It provides instructions on how to fill out the VT Form LRC-140 and what documents are required.
This form is used for providing informed consent for receiving the Covid-19 vaccination in Vermont. It includes important information about the vaccine and allows individuals to make an informed decision about receiving the immunization.
This form is used for notifying the Washington Department of Health about the operation of a mobile unit by a behavioral health agency.
This form is used for the intake of patients with tuberculosis (TB) in the state of Washington.
This form is used for disclosing information about farm labor contractors and workers in Washington. It is available in Somali.
This document is used for disclosing information about farm labor contractors and workers in Washington who are of Cambodian nationality.
This form is used for reporting confidential sexually transmitted disease cases in Pacific County, Washington.
This document is used for requesting participation in the Farmer's Market Nutrition Program (FMNP) and the Senior Farmers' Market Nutrition Program (SFMNP) in Washington state.