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74
![DOEA Form 235 "Affidavit of Compliance - Employer" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783747/form-235-affidavit-compliance-employer-florida.png "DOEA Form 235 "Affidavit of Compliance - Employer" - Florida")
![DOEA/OPPG Form 002 "Professional Guardian Employee Registration Form" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17838/1783819/doea-oppg-form-002-professional-guardian-employee-registration-form-florida.png "DOEA/OPPG Form 002 "Professional Guardian Employee Registration Form" - Florida")
DOEA/OPPG Form 002 "Professional Guardian Employee Registration Form" - Florida
Size: 284 KB
2 pages
![DOEA/SPGO Form 001 "Professional Guardian Registration Form" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17838/1783820/doea-spgo-form-001-professional-guardian-registration-form-florida.png "DOEA/SPGO Form 001 "Professional Guardian Registration Form" - Florida")
![DOEA Form 236 "Affidavit of Compliance - Employee" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783752/form-236-affidavit-compliance-employee-florida.png "DOEA Form 236 "Affidavit of Compliance - Employee" - Florida")
![DOEA Form ALF/ADRD-002 "Alzheimer's Disease and Related Disorders Training Three-Year Curriculum Certification" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783734/form-alf-adrd-002-alzheimer-s-disease-and-related-disorders-training-three-year-curriculum-certification-florida.png "DOEA Form ALF/ADRD-002 "Alzheimer's Disease and Related Disorders Training Three-Year Curriculum Certification" - Florida")
![DOEA Form ALF/ADRD-001 "Alzheimer's Disease and Related Disorders Training Provider Certification" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783737/form-alf-adrd-001-alzheimer-s-disease-and-related-disorders-training-provider-certification-florida.png "DOEA Form ALF/ADRD-001 "Alzheimer's Disease and Related Disorders Training Provider Certification" - Florida")
![DOEA Form 234 "Application for Designation of a Home Health Agency as a Teaching Agency for Home and Community-Based Care" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783795/form-234-application-designation-a-home-health-agency-as-a-teaching-agency-home-and-community-based-care-florida.png "DOEA Form 234 "Application for Designation of a Home Health Agency as a Teaching Agency for Home and Community-Based Care" - Florida")
![Form CCE-001 "Cce Impartial Decisionmaker Application" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17658/1765884/form-cce-001-cce-impartial-decisionmaker-application-florida.png "Form CCE-001 "Cce Impartial Decisionmaker Application" - Florida")
![Form LTCOP-001 "Case Investigation - Confidential" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17658/1765882/form-ltcop-001-case-investigation-confidential-florida.png "Form LTCOP-001 "Case Investigation - Confidential" - Florida")
![Form ALFCT-002 "Application for Assisted Living Facility (Alf) Core Training Provider Registration" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17658/1765890/form-alfct-002-application-assisted-living-facility-alf-core-training-provider-registration-florida.png "Form ALFCT-002 "Application for Assisted Living Facility (Alf) Core Training Provider Registration" - Florida")
![Form 001 "Professional Guardian Registration Form" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17658/1765886/form-001-professional-guardian-registration-form-florida.png "Form 001 "Professional Guardian Registration Form" - Florida")
![DOEA Form HH/ADRD-001 "Application for Home Health Care Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783738/form-hh-adrd-001-application-home-health-care-training-provider-certification-alzheimer-s-disease-or-related-disorders-training-florida.png "DOEA Form HH/ADRD-001 "Application for Home Health Care Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida")
![DOEA Form ADC/ADRD-001 "Application for Adult Day Care Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783735/form-adc-adrd-001-application-adult-day-care-training-provider-certification-alzheimer-s-disease-or-related-disorders-training-florida.png "DOEA Form ADC/ADRD-001 "Application for Adult Day Care Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida")
![DOEA Form Hospice/ADRD-001 "Application for Hospice Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783739/form-hospice-adrd-001-application-hospice-training-provider-certification-alzheimer-s-disease-or-related-disorders-training-florida.png "DOEA Form Hospice/ADRD-001 "Application for Hospice Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida")
![DOEA Form Hospice/ADRD-002 "Application for Hospice Three-Year Curriculum Certification - Alzheimer's Disease or Related Disorders Training" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783740/form-hospice-adrd-002-application-hospice-three-year-curriculum-certification-alzheimer-s-disease-or-related-disorders-training-florida.png "DOEA Form Hospice/ADRD-002 "Application for Hospice Three-Year Curriculum Certification - Alzheimer's Disease or Related Disorders Training" - Florida")
![DOEA Form 183 "Request for Restriction on Use & Disclosure of Medical Information and/or Confidential Communication" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17638/1763897/doea-form-183-request-for-restriction-on-use-disclosure-of-medical-information-and-or-confidential-communication-florida.png "DOEA Form 183 "Request for Restriction on Use & Disclosure of Medical Information and/or Confidential Communication" - Florida")
![DOEA Form 187 "Revocation of Authorization to Release Protected Health Information (Phi)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763901/doea-form-187-revocation-of-authorization-to-release-protected-health-information-phi-florida.png "DOEA Form 187 "Revocation of Authorization to Release Protected Health Information (Phi)" - Florida")
![DOEA Form 184 "Access to Records Request for Inspection of Protected Health Information (Phi)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17638/1763898/doea-form-184-access-to-records-request-for-inspection-of-protected-health-information-phi-florida.png "DOEA Form 184 "Access to Records Request for Inspection of Protected Health Information (Phi)" - Florida")
![DOEA Form 188 "Complaint Form" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763902/doea-form-188-complaint-form-florida.png "DOEA Form 188 "Complaint Form" - Florida")
![DOEA Form 190 "HIPAA Fax Cover Sheet" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763904/doea-form-190-hipaa-fax-cover-sheet-florida.png "DOEA Form 190 "HIPAA Fax Cover Sheet" - Florida")
![DOEA Form 185 "Amendment/Correction of Health Record Request Form" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17638/1763899/doea-form-185-amendment-correction-of-health-record-request-form-florida.png "DOEA Form 185 "Amendment/Correction of Health Record Request Form" - Florida")
![DOEA Form 181 "Employee Statement of Understanding of Privacy Policies" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17638/1763895/doea-form-181-employee-statement-of-understanding-of-privacy-policies-florida.png "DOEA Form 181 "Employee Statement of Understanding of Privacy Policies" - Florida")
![DOEA Form 189 "Client Disclosure Log" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763903/doea-form-189-client-disclosure-log-florida.png "DOEA Form 189 "Client Disclosure Log" - Florida")
![DOEA Form 182 "Authorization to Use or Disclose Health Information" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17638/1763896/doea-form-182-authorization-to-use-or-disclose-health-information-florida.png "DOEA Form 182 "Authorization to Use or Disclose Health Information" - Florida")
![DOEA Form 186 "Request for Accounting of Disclosures of Protected Health Information" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763900/doea-form-186-request-for-accounting-of-disclosures-of-protected-health-information-florida.png "DOEA Form 186 "Request for Accounting of Disclosures of Protected Health Information" - Florida")
![DOEA Form ADRD-001 "Application for Nursing Home Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783742/form-adrd-001-application-nursing-home-training-provider-certification-alzheimer-s-disease-or-related-disorders-training-florida.png "DOEA Form ADRD-001 "Application for Nursing Home Training Provider Certification - Alzheimer's Disease or Related Disorders Training" - Florida")
![DOEA Form 154 Attachment 1 "Community Care for the Elderly (Cce) and Alzheimer's Disease Intitative (Adi) Eligibility Financial Worksheet and Assessed Co-payment Form" - Florida, 2019](https://data.templateroller.com/pdf_docs_html/2001/20010/2001085/doea-form-154-attachment-1-community-care-for-the-elderly-cce-and-alzheimer-s-disease-intitative-adi-eligibility-financial-worksheet-and-assessed-co-payment-form-florida.png "DOEA Form 154 Attachment 1 "Community Care for the Elderly (Cce) and Alzheimer's Disease Intitative (Adi) Eligibility Financial Worksheet and Assessed Co-payment Form" - Florida, 2019")
![Instructions for DOEA Form 154 Attachment 4 "Eligibility Financial Worksheet and Assessed Co-payment Form" - Florida, 2018](https://data.templateroller.com/pdf_docs_html/1783/17837/1783789/attachment-4-instructions-doea-form-154-eligibility-financial-worksheet-and-assessed-co-payment-form-2018.png "Instructions for DOEA Form 154 Attachment 4 "Eligibility Financial Worksheet and Assessed Co-payment Form" - Florida, 2018")
![Form 701A "Condensed Assessment" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17656/1765687/form-701a-condensed-assessment-florida.png "Form 701A "Condensed Assessment" - Florida")
![Form 701C "Congregate Meals Assessment" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17656/1765688/form-701c-congregate-meals-assessment-florida.png "Form 701C "Congregate Meals Assessment" - Florida")
![DOEA Form 701B "Comprehensive Assessment" - Florida](https://data.templateroller.com/pdf_docs_html/1783/17837/1783772/form-701b-comprehensive-assessment-florida.png "DOEA Form 701B "Comprehensive Assessment" - Florida")
![ACHA Form 5000-3008 "Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form" - Florida](https://data.templateroller.com/pdf_docs_html/2075/20759/2075910/acha-form-5000-3008-medical-certification-for-medicaid-long-term-care-services-and-patient-transfer-form-florida.png "ACHA Form 5000-3008 "Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form" - Florida")
!["Catering Information Form" - Florida](https://data.templateroller.com/pdf_docs_html/2109/21099/2109938/catering-information-form-florida.png ""Catering Information Form" - Florida")
!["CACFP Meal Benefit Income Eligibility Form (Adult Care)" - Florida](https://data.templateroller.com/pdf_docs_html/2085/20856/2085602/cacfp-meal-benefit-income-eligibility-form-adult-care-florida.png ""CACFP Meal Benefit Income Eligibility Form (Adult Care)" - Florida")
!["Formulario CACFP De Admisibilidad Para Beneficios Alimentarios Conforme a Los Ingresos (Cuidado De Adultos)" - Florida (Spanish)](https://data.templateroller.com/pdf_docs_html/2085/20856/2085603/formulario-cacfp-de-admisibilidad-para-beneficios-alimentarios-conforme-a-los-ingresos-cuidado-de-adultos-florida-spanish.png ""Formulario CACFP De Admisibilidad Para Beneficios Alimentarios Conforme a Los Ingresos (Cuidado De Adultos)" - Florida (Spanish)")
!["Public News Release for Non-pricing Programs" - Florida](https://data.templateroller.com/pdf_docs_html/2001/20010/2001087/public-news-release-for-non-pricing-programs-florida.png ""Public News Release for Non-pricing Programs" - Florida")
!["Publicacion Del Comunicado De Prensa Para Programas Sin Tarifa" - Florida (Spanish)](https://data.templateroller.com/pdf_docs_html/2001/20010/2001088/publicacion-del-comunicado-de-prensa-para-programas-sin-tarifa-florida-spanish.png ""Publicacion Del Comunicado De Prensa Para Programas Sin Tarifa" - Florida (Spanish)")
"Publicacion Del Comunicado De Prensa Para Programas Sin Tarifa" - Florida (Spanish)
Size: 109 KB
2 pages
