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Accountable Health Care IPA LOS ANGELES DIRECT REFERRAL FORM Tel: (562) 4353333 Fax: (562) 5950673 The purpose of this Direct Referral Form is to provide direct access by our patients to selected

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How to fill out DA Form LA 091615DOC:

1. Start by gathering all the necessary information and documents related to the form. This may include personal identification details, employment history, and any relevant supporting documents.
2. Carefully read the instructions provided on the form to understand the purpose and requirements for each section. This will help ensure that you provide accurate and complete information.
3. Begin by filling out the personal information section, including your full name, contact details, social security number, and any other required information. Make sure to double-check the accuracy of each entry.
4. If applicable, proceed to the employment history section. Provide details about your previous jobs, such as job title, employer's name, dates of employment, and job duties performed. Include any relevant certifications or licenses obtained during these periods.
5. Move on to the education section, where you should provide information about your educational background. Include details about schools attended, degrees obtained, and any specialized training or courses completed.
6. If the form requires you to disclose any criminal history, carefully answer the questions in this section. Provide accurate and honest information, including any convictions or pending charges.
7. Depending on the purpose of the form, there may be additional sections to fill out, such as references or medical information. Follow the instructions provided and fill out these sections accordingly.
8. Review the completed form for any errors or missing information before submitting it. Ensure that all sections have been appropriately filled out and that your handwriting is legible.

Who needs DA Form LA 091615DOC?

1. Military personnel: This form may be required for members of the armed forces to document their personal information, employment history, education, and other related details.
2. Security clearance applicants: Individuals applying for security clearances, such as those required for certain military or government positions, may need to fill out this form as part of the application process.
3. Government employees: Depending on their job requirements and the specific agency they work for, government employees may be required to complete this form for various administrative purposes.

Note: The specific need for DA Form LA 091615DOC may vary depending on the organization or agency involved. It is important to consult the appropriate guidelines or instructions to determine if this form is required in your particular situation.

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