Get the free 96 Medical waiver statement 04-2014 - losrios
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LOS RIOS COMMUNITY COLLEGE DISTRICT MEDICAL PLAN WAIVER FORM SECTION I: PERSONAL INFORMATION LAST NAME (PRINT) FIRST NAME (PRINT) LOS RIOS EMPLOYEE ID # DATE OF HIRE SECTION II: WAIVING COVERAGE DECLINATION
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How to fill out 96 medical waiver statement
01
The 96 medical waiver statement is typically required by individuals who are seeking a waiver for medical conditions or disabilities that may affect their ability to meet certain requirements or participate in certain activities.
02
When filling out the 96 medical waiver statement, it is important to provide accurate and detailed information about your medical condition or disability. This may include the specific diagnosis, treatments received, medications being taken, and any limitations or accommodations needed.
03
You will also need to provide information about your healthcare provider, including their name, contact information, and any relevant certifications or credentials. This is important as it helps establish the credibility of your medical information.
04
It may be helpful to include any supporting documentation or medical records that can further validate your medical condition or disability. These can provide additional evidence to support your request for a waiver.
05
Be sure to read the instructions provided with the 96 medical waiver statement carefully and follow any specific guidelines or requirements. This will help ensure that your application is complete and accurate.
06
Once you have completed the 96 medical waiver statement, review it for any errors or omissions and make any necessary corrections. It is important to double-check all information before submitting the waiver statement to avoid delays or complications in the processing of your request.
In summary, anyone who requires a waiver for medical conditions or disabilities that may affect their ability to meet requirements or participate in certain activities may need to fill out a 96 medical waiver statement. When completing this statement, it is important to provide accurate and detailed information, include any supporting documentation, and follow the instructions provided.
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