№ files_lp_4_process_3_132533
File format: docx
Character count: 2012
File size: 924 KB
Form for requesting HSCSN authorization for enrollee participation in a summer program, including program details, practitioner attestation, and payment instructions.
Year:
2021
Region / City:
United States
Subject:
Summer program coverage for enrollees
Document Type:
Authorization request form
Organization / Institution:
HSCSN
Author:
Treating physician or nurse practitioner
Target Audience:
Enrollees and caregivers
Program Period:
Between Memorial Day and Labor Day 2021
Maximum Coverage Amount:
$2000
Covered Services:
Summer program participation only; excludes medical transport, personal care, home health, ABA, and other therapies during program hours
Submission Method:
Fax or email to HSCSN Utilization Management
Payment Options:
Reimbursement to caregiver or direct payment to program
Price: 8 / 10 USD
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The file will be delivered to the email address provided at checkout within 12 hours.
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Note:
Request Submission Date
Date of Request:
12/2022
Note:
Year
Organization / Institution:
U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation
Year:
2023
Region / City:
United States
Topic:
Medical authorization and billing
Document type:
Official form
Organization / Institution:
Department of Veterans Affairs
Author:
Department of Veterans Affairs
Target audience:
Healthcare providers, Veterans
Period of validity:
From date of issue
Date of approval:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / City:
Iowa, Des Moines
Subject:
Proposal Certification and Authorization to Release Information
Document Type:
Certification Letter
Issuing Organization:
Iowa Workforce Development
Author:
Michael Drottz
Target Audience:
Respondents to RFP 309MD24001
Period of Validity:
N/A
Approval Date:
N/A
Date of Revision:
N/A
Note:
Year
Organization / Institution:
Minnesota Department of Education
Target Audience:
School District Superintendents, Early Education Staff
Year:
2023
Region / City:
United States
Topic:
Personnel vetting, security clearance
Document Type:
Questionnaire, Authorization Form
Agency:
Federal Government
Author:
Unknown
Target Audience:
Individuals undergoing personnel vetting
Period of Validity:
Until termination of affiliation with the Federal Government or position requirement
Approval Date:
Not specified
Amendment Date:
Not specified
Document type:
Access authorization form
System:
Enterprise Income Verification (EIV)
Program area:
Multifamily Housing
Issuing organization:
U.S. Department of Housing and Urban Development
Legal basis:
Paperwork Reduction Act of 1995; Federal Privacy Act
OMB control number:
2502-0204
Purpose:
Initial or reinstated access to the Multifamily EIV system and acknowledgment of Rules of Behavior
Target users:
Multifamily Housing Coordinators and Contract Administrator Coordinators
Submission method:
Fax or email to HUD Multifamily Helpdesk
Access duration:
Up to one year before recertification
Security framework:
HUD Security Program Policy; HUD Handbook 2400.25 Rev. 1
Data sensitivity:
Personally identifiable information
Note:
Year
Theme:
Foster Care, Residential Care
Document Type:
Authorization Form
Organization / Institution:
Texas Department of Family and Protective Services (DFPS)
Target Audience:
Caregivers, Caseworkers
Year:
2026
Region / City:
N/A
Subject:
Prior authorization requirements for lower extremity endovascular procedures
Document type:
Checklist
Organization:
N/A
Author:
N/A
Target audience:
Healthcare providers
Period of validity:
N/A
Approval date:
N/A
Date of amendments:
N/A
Year:
2023
Region / City:
University of Kentucky
Subject:
Research Study Participation
Document Type:
Consent Form
Institution:
University of Kentucky
Author:
Research Team
Target Audience:
Potential research participants
Study Duration:
Variable (hours, days, months, years)
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2014
Region / City:
United States
Topic:
Medication Administration, Medical Authorization
Document Type:
Authorization Form
Organization / Institution:
245D licensed program
Author:
Not specified
Target Audience:
Individuals receiving medication assistance, legal representatives
Period of Validity:
Ongoing
Approval Date:
January 1, 2014
Date of Changes:
Not specified
Note:
Year
Topic:
Research, Health Information, Privacy
Document Type:
Authorization Form
Institution:
University of Miami, Jackson Health Systems
Target Audience:
Participants in Research Studies
Year:
Not specified
Region / City:
Not specified
Subject:
Health research, consent, data sharing
Document type:
Authorization form
Organization / Institution:
Medical College of Wisconsin
Author:
Not specified
Target audience:
Researchers, Institutional administrators
Period of validity:
Not specified
Approval date:
Not specified
Date of amendments:
Not specified
Year:
[Insert Year]
Region / City:
[Insert City, State ZIP]
Theme:
Medical Treatment Authorization
Document Type:
Authorization Request
Organization:
[Insert Payer Name]
Author:
[Insert Healthcare Provider’s Name]
Target Audience:
Medical Director or individual responsible for prior authorization
Period of Validity:
[Insert Date Range if Applicable]
Approval Date:
[Insert Date if Available]
Amendment Date:
[Insert Date if Applicable]
Note:
Year
Organization / Institution:
Oregon State University
Academic year:
Fall 2014 – Summer 2015
Program:
Master of Business Administration (MBA)
Institution:
University
Document type:
Program requirements guide
Credits required:
42 credits plus prerequisites
Prerequisite credits:
0–15
Core credits:
24
Elective credits:
9
Courses format:
3 credits per course unless noted
Target audience:
MBA applicants and enrolled students
Policy notes:
Subject to change; not a contractual document
Concentrations available:
Organizational & Human Resource Management; Project Management; Information Assurance and Security; Management Information Systems
Source type:
Academic program curriculum guide
Year:
2024
Region / City:
South Carolina
Subject:
Transportation Services
Document Type:
Invitation for Bid
Organization / Institution:
South Carolina Department of Transportation
Author:
South Carolina Department of Transportation
Target Audience:
Vendors and Contractors
Effective Period:
December 2024 – January 2025
Approval Date:
11/14/2024
Amendment Date:
01/15/2025
Year:
2022
Region / City:
Radford, Virginia; Blacksburg, Virginia; New Castle, Virginia; Roanoke, Virginia; Bristol, Tennessee
Theme:
Summer Camps for Youth with Disabilities
Document Type:
Program Information
Author:
Not specified
Target Audience:
Families of children with disabilities
Period of Action:
Summer 2022
Approval Date:
Not specified
Amendment Date:
Not specified