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This Form is used for reporting a patient's medical information by their attending physician in the state of Virginia.

This document provides information about the different levels and types of amputations in the state of Virginia.

This document is a pre-mediation statement used in Virginia for contesting an original claim. It provides a comprehensive and final overview of the disputed claim before entering into mediation.

This Form is used for responding to a change in condition claim in the state of Virginia.

This Form is used for healthcare providers in Virginia to respond to an application for medical care provider enrollment.

This form is used for reporting the annual payroll of a city, town, or county that operates as a self-insurer in Virginia. It provides information on the wages paid to employees and helps in determining insurance premiums.

This type of document, the VWC Form 35 Fatal Award Agreement, is used in Virginia for the settlement of worker's compensation claims involving fatal injuries.

This form is used for reporting incidents that occur in health homes in Washington state. It is used to document any unexpected events or occurrences that could impact the health and safety of individuals receiving services in health home programs.

This Form is used for individuals in Ventura County, California to request a duplicate check. It is an affidavit form that verifies the need for a replacement check.

This form is used for signing an agreement to pay for healthcare services in the state of Washington.

This form is used for submitting a bidder's MWSBE (Minority and Women-owned Small Business Enterprise) participation plan for city contracts in Houston, Texas.

This form is used for filing a proposed order and stipulation to continue trial, FSC (Final Status Conference), and related motion/discovery dates in personal injury courts in the North District of the County of Los Angeles, California.

This document is the Grand Jury Citizen Complaint Form, used in the County of Los Angeles, California. It allows citizens to file complaints with the grand jury regarding any alleged misconduct or wrongdoing by public officials or agencies.

This Form is used for filing an application for rehearing and order under Welfare and Institutions Code Section 252 in Los Angeles County, California.

This form is used for filing a government claim with the judicial branch in the County of Los Angeles, California.

This form is used for submitting payment notices to the County of Los Angeles, California. It is a document that allows individuals or businesses to notify the county of their intent to make a payment for a particular service or fee.

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