№ files_lp_4_process_2_81147
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Character count: 4538
File size: 81 KB
Structured application form for health service providers collecting professional, demographic, and service-related information for participation in the ESI Employee Assistance Program.
Year:
2026
Region / City:
Wellsville, NY, USA
Type of Document:
Application Form
Organization / Institution:
ESI Employee Assistance Program
Intended Audience:
Health service providers and clinicians
Fields of Service:
Mental health, counseling, telehealth, workplace services
Licenses/Certifications:
Professional licenses and certifications required for practice
Insurance Panels:
Aetna, BCBS, Cigna, Medicaid, Medicare, and other listed insurers
Optional Demographics:
Gender, religion, ethnicity, military experience, languages, sign language
Availability:
Days, evenings, weekends
Submission Methods:
Email, Fax, Mail
Authorization:
Verification of professional information and consent for information sharing
Signature Requirement:
Applicant signature and date
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2025
Location:
Wellsville, NY, USA
Type of document:
Meeting minutes
Organization:
Wellsville Joint Recreation Commission
Participants:
Dustin Gardner, Dustin Donovan, Mindi Nelson, Zach Devorss, Bernie Smith
Audience:
Public attendees (none present)
Topics:
Agenda adoption, public forum, business by consent, information items, discussion items, administrative reports, executive session, adjournment
Date of meeting:
March 5, 2025
Time of meeting:
6:00 PM – 7:15 PM
Year:
2026
Region / City:
Wellsville, NY, US
Document Type:
Application Form
Organization:
ESI Employee Services
Author:
Human Resources Department
Target Audience:
Healthcare providers and licensed practitioners
Purpose:
Enrollment and information collection for provider network
Modality:
Telehealth, Face to Face
Specializations:
Affective Disorders, Marriage/Couples, Grief, Phobias, Drug/Alcohol Evaluation and Treatment, Trauma/PTSD, Family Counseling, Christian Counseling, Children, LGBTQ, EMDR, Military/Veteran, Administrative Referrals
Insurance Panels:
Aetna, Fidelis, Independent Health, MVP, BCBS, Geisinger, Kaiser, NYSHIP, Beacon/Carelon, Harvard Pilgrim, Magellan, Optum, Medicaid, Medicare, Tricare/Champus, Cigna, Health Net, Tufts, Humana, Moda, UHC/UBH/UMR/Optum
Optional Demographics:
Gender, Religion, Ethnicity, Military Experience, Languages, Sign Language
Workplace Services:
On-site services, Direct services to employers
Authorization:
Verification of professional competence and release of relevant information
Jurisdiction:
Indiana
Legal area:
Civil procedure
Document type:
Stipulated discovery protocol
Subject matter:
Pretrial discovery
Governing rules:
Indiana Rules of Trial Procedure
Discovery scope:
Non-ESI discovery
Discovery pathways:
Streamlined, General, Complex
Parties involved:
Litigating parties in a civil action
Procedural stage:
Pretrial discovery
Obligations:
Initial disclosures and discovery limitations
Applies to:
Civil litigation cases subject to court approval
Court involvement:
Court-approved or court-ordered protocol
Note:
Year
Document Type:
Legal Agreement
Year:
2024
Region / City:
Clinton County
Topic:
Legal cases
Document type:
Court case record
Organization / Institution:
Clinton County
Author:
Unknown
Target audience:
Legal professionals, public
Period of validity:
Not specified
Approval date:
Not specified
Modification date:
Not specified
Description:
Legal case record related to ongoing court proceedings involving multiple parties in Clinton County.
Note:
Year
Region:
Eastern South Island
Topic:
Tracks and Group Size Regulations
Document Type:
Guidelines
Year:
2026
Organization:
Employee Services, Inc. d/b/a ESI Employee Assistance Group (ESI)
Document Type:
Authorization form
Subject:
Employee Assistance Program records disclosure
Employee Name:
[Provided in document]
Date of Birth:
[Provided in document]
Employer Name:
[Provided in document]
Employer Representative:
[Provided in document]
Purpose of Disclosure:
Coordination of treatment planning, monitoring compliance, evaluating cooperation and motivation in workplace behavior
Applicable Law:
42 C.F.R. Part 2, HIPAA 45 C.F.R. 164
Authorization Expiration:
One year from signature date
Revocation Policy:
Can be revoked in writing at any time
Access Rights:
Employee may inspect and copy records
Witness:
[Provided in document]
Year:
2018
Region / City:
United States
Topic:
Workplace Harassment, Disability, Discrimination
Document Type:
Informational Series
Organization:
Job Accommodation Network
Author:
Jeff Daniels, Ph.D.
Target Audience:
Employees, Employers, HR Professionals
Period of Validity:
Not specified
Date of Approval:
05/31/2018
Date of Changes:
Not specified
Year:
2024
Note:
Region / City
Topic:
Employee Assistance Program, Benefits
Document Type:
Form
Period of validity:
2024-2028
Year:
Not specified
Region / City:
Denver
Topic:
Emergency preparedness for special events
Document type:
Guidance document
Issuing body:
City of Denver
Intended users:
Event planners and organizers
Scope:
Special events
Related plan type:
Emergency Action Plan (EAP)
Coverage areas:
Event details, command and communication, weather, health and medical, safety and security
Includes appendices:
Yes
Includes sample forms and charts:
Yes
Year:
2022
Region / City:
Melbourne
Theme:
Electrical Safety, High Voltage
Document Type:
Safety Procedure
Organization:
Melbourne Water
Author:
Not specified
Target Audience:
Employees, Contractors
Period of validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2017
Region / City:
Victoria, Australia
Subject:
Employee Assistance Programs, Diversity, Mental Health, Public Sector
Document Type:
Guideline
Organ / Institution:
Victorian Public Sector Commission
Author:
Victorian Public Sector Commission
Target Audience:
Human Resource staff, Occupational Health and Safety officers, Contract Managers
Period of Validity:
2017–2022
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2026
Region / City:
North Carolina
Topic:
Dam Safety, Emergency Action Planning
Document Type:
Guidelines
Organization:
North Carolina Dam Safety Program
Author:
North Carolina Department of Environmental Quality
Target Audience:
Dam Owners, Emergency Managers
Period of Validity:
Annual updates required
Approval Date:
N/A
Revision Date:
January (annually)
Year:
2013
Region / city:
California
Topic:
Emergency Action Plan, Dam Safety
Document Type:
Template
Organ / Institution:
California Governor’s Office of Emergency Services, Dam Safety Planning Division
Author:
California Governor’s Office of Emergency Services
Target Audience:
Dam owners, operators, and emergency managers in California
Period of validity:
N/A
Approval Date:
N/A
Date of changes:
N/A
Description:
Template to assist dam owners with structuring Emergency Action Plans in compliance with required components.
Year:
2015
Region / City:
N/A
Theme:
SSL Configuration
Document Type:
Technical Guide
Organization / Institution:
N/A
Author:
N/A
Target Audience:
System administrators, Developers
Effective Period:
N/A
Approval Date:
N/A
Modification Date:
N/A
Year:
2026
Region / City:
United States
Theme:
Employee Assistance Programs, Workplace Performance
Document Type:
Handbook
Organization / Institution:
Carilion EAP
Author:
Carilion EAP Consultants
Target Audience:
Supervisors, Human Resources, and Employees
Period of Action:
Ongoing
Approval Date:
N/A
Date of Changes:
N/A
Note:
Year
Region / City:
Indianapolis, IN
Topic:
Utility & Rent Assistance, Food/Clothing Assistance, Housing Assistance/Shelters, Additional Assistance
Document Type:
Referral List
Organization / Institution:
Various Nonprofits and Government Agencies
Target Audience:
Residents of Indianapolis in need of assistance
Level:
4
Credits:
5
Purpose:
English for Academic Purposes (EAP) unit standards are designed to assess a learner’s readiness to study at undergraduate level. Learners credited with this unit standard are able to listen to and process information from a spoken academic text in English for an academic purpose.
Classification:
Languages > English for Academic Purposes
Available grade:
Achieved
Guidance Information:
This unit standard is one of a suite of five English for Academic Purposes Level 4 standards. It contributes to the New Zealand Certificate in English Language (Academic) (Level 4) [Ref: 1883]. The requirements of this standard are consistent with the NZCEL Guiding Document. This document includes guidelines relating to appropriate text, task specifications, and assessment conditions and can be found at http://www.nzqa.govt.nz
. This unit standard is at a level comparable to the Common European Framework of Reference (CEFR) mid B2. A structured overview of all CEFR related scales can be found at http:
//www.coe.int/en/web/portfolio/overview-of-cefr-related-scales
Note:
. It is recommended that assessment against this unit standard is conducted in conjunction with assessment against other Level 4 English for Academic Purposes unit standards. Assessment may occur in conjunction with study and assessment in other learning areas.
Spoken material:
must be at least eight minutes in length; must be one spoken text: monologue or dialogue; must be at a language level of sufficient complexity to satisfy the academic requirements of university entrance; may include visual aids that must not include information required to answer the questions; must be listened to uninterrupted; can be listened to only twice.
Listeners’ purpose:
The listeners’ purpose should be determined by the assessor and clearly communicated to the learners.
Assessment support material for English for Academic Purposes unit standards can be found at:
www.nzqa.govt.nz/asm
Outcome 1:
Listen to and process information from a spoken academic text.
Range:
form may include – visuals, oral, written.
Planned review date:
31 December 2028
Process:
Version: Date: Last Date for Assessment
Registration:
1 19 March 2010 31 December 2012
Review:
2 19 July 2012 31 December 2019
Rollover and Revision:
3 16 April 2015 31 December 2019
Rollover:
5 28 July 2022 31 December 2025
Consent and Moderation Requirements (CMR) reference:
0226
This CMR can be accessed at http:
//www.nzqa.govt.nz/framework/search/index.do
Comments on this unit standard:
Please contact NZQA National Qualifications Services [email protected]
Year:
2022
Region / City:
Northern Ireland
Subject:
Employee Assistance Programme (EAP) Service
Document Type:
Commercial Conditions of Contract
Organization:
NICSHR
Author:
Unknown
Target Audience:
Public sector stakeholders
Contract Period:
Not specified
Date of Approval:
Not specified
Date of Changes:
Not specified
End of Document:
Not specified