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FORM ORT1 REVISED 03/2014 THIS REPORT IS DUE ON OR BEFORE APRIL 15, 2014, STATE HEALTH PLANNING AND DEVELOPMENT AGENCY MAILING ADDRESS (U.S. Postal Service) STREET ADDRESS (Commercial Carrier) PO
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Individuals applying for state-sponsored healthcare programs or benefits may be required to fill out page 1 of the state health form. These programs could include Medicaid, CHIP (Children's Health Insurance Program), or other similar state health initiatives.
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Employees working in certain industries or job positions that require regular health screenings or monitoring may be requested to fill out page 1 of the state health form. This ensures that employers have up-to-date health information to promote a safe and healthy work environment.
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Page 1 state health is a form used to report health information to the state.
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The purpose of page 1 state health is to collect information about health coverage offered to employees.
Information such as the employer's name, address, tax ID number, and details about the health coverage provided must be reported on page 1 state health.
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