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APPLICATION FOR ADMISSION ASB URY PLAYSCHOOL 1331 Hwy 42 Petal, MS 39465 20132014 SCHOOL YEAR (PLEASE TYPE OR PRINT) STUDENTS FULL NAME:LASTFIRSTMIDDLEGOES HOME ADDRESS:STREETCITYDATE OF BIRTH:STATE
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Read the instructions carefully
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Start by providing personal information such as name, date of birth, and contact details
03
Provide details of the serious illness, including the diagnosis, date of diagnosis, and treating physician
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Include any additional medical documentation or reports to support the application
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Fill out the sections regarding financial impact and any available insurance coverage
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Double-check all the information and make sure it is accurate and complete
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Submit the filled-out serious illness form to the concerned authority or insurance provider

Who needs serious illness?

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Anyone who has been diagnosed with a serious illness
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Individuals who require financial support to cope with the expenses related to their illness
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Those who have insurance coverage that includes serious illness benefits
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People who want to apply for disability benefits or other assistance programs related to serious illnesses
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A serious illness is a health condition that is severe and potentially life-threatening.
Anyone who has been diagnosed with a serious illness is required to file the necessary documentation.
To fill out serious illness, you will need to provide details about your diagnosis, treatment plan, and any other relevant medical information.
The purpose of serious illness reporting is to ensure that individuals receive the necessary support and accommodations for their health condition.
You must report details about your diagnosis, treatment plan, and any other relevant medical information.
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