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Home care Worker ApplicationOffice Use OnlyProvider #: Seniors and People with Disabilities Oregon Home Care Commissionaire Restricted Please print (use blue or black ink), sign and date application.
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How to fill out provider

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Next, determine the type of provider you are dealing with, such as a healthcare provider, service provider, or product provider.
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Provider refers to an entity or individual that supplies goods or services.
The entity or individual who is providing the goods or services is required to file provider.
Provider can be filled out by providing all necessary information about the goods or services supplied.
The purpose of provider is to document the transaction between the provider and the recipient of goods or services.
Information such as the date of transaction, description of goods or services, quantity, price, and recipient's information must be reported on provider.
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