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THIS FORM MUST BE COMPLETED IN THE ENTIRETY
BY THE PATIENT OR THE PATIENTS AUTHORIZED REPRESENTATIVETRIHEALTH, INC. AND THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO
AUTHORIZATION FOR USE OR DISCLOSURE
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What is this form must be?
This form must be a W-2 form.
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Employers are required to file this form.
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This form must be filled out with employee's wage and tax information.
What is the purpose of this form must be?
The purpose of this form is to report wages and taxes withheld for employees.
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Information such as employee's wages, tips, and other compensation must be reported.
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