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E2 EMPLOYEE HEALTH SERVICES NON-DHS/NON-COUNTY WORKFORCE MEMBER HEALTH CLEARANCE CERTIFICATION Instructions: Section A shall be completed by the non-DHS/non-County workforce member's (WFM) physician
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Obtain the necessary forms from your employer or the relevant authority.
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Fill in your personal information, such as your name, date of birth, and contact details.
04
Provide information about your current employment, including your job title, department, and employer's contact details.
05
Indicate whether you are a full-time or part-time employee.
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Who needs non-dhsnon-county workforce member health:

01
Employees who are not part of the Department of Homeland Security (non-DHS).
02
Workers who are not affiliated with any county government (non-county).
03
Those who are part of the workforce, whether full-time or part-time, excluding certain categories like contractors or temporary staff.
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The non-dhsnon-county workforce member health is a healthcare program that provides medical benefits to individuals who are not employed by the Department of Human Services (DHS) and are not residents of a specific county.
Employers who have non-dhsnon-county workforce members on their payroll are required to file for non-dhsnon-county workforce member health benefits.
To fill out the non-dhsnon-county workforce member health form, employers need to provide information about the non-dhsnon-county workforce members, such as their name, employment status, and healthcare coverage options.
The purpose of the non-dhsnon-county workforce member health program is to ensure that individuals who are not eligible for DHS benefits or county-level healthcare programs still have access to medical benefits through their employers.
The information that must be reported on the non-dhsnon-county workforce member health form includes the names and employment statuses of the non-dhsnon-county workforce members, the healthcare coverage options provided by the employer, and any other relevant details.
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Related Links

ORIENTATION / REORIENTATION
This handbook provides information regarding Harbor-UCLA, Department of Health Services, and Los Angeles County policies. Please take the time to thoroughly ...
Orientation/Reorientation Handbook - Lacounty
All Harbor-UCLA workforce members must complete all mandatory training and competency certification requirements for their respective positions [e.g. ...
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Non-County – For use by non-County workforce members to obtain annual health screening clearance. ... Harbor-UCLA Medical Center · Los Angeles General ...

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Relevant keywords

dhs EHS WFM E2 E-NC nonCounty K-NC N-95 BIRTHDATE postexposure B-NC N-NC P-NC nonDHS Rubella ATD E-MAIL O-NC Los Varicella 2010 Declination respirators compliant applicable regulatory auditing WORKFORCE CERTIFICATION pre

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