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AV515 Code Summary Form for Reimbursement Requests
AIRPORT NAME:
WBS #:Reimbursement
Request Total:Reimbursement Request #:Total this Page:Vendor
NameInvoice×Invoice
DateInvoice
Amount ($)Sales
Tax
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How to fill out av-515 a-code summary form
01
To fill out the AV-515 A-Code Summary form, follow these steps:
02
Start by entering the relevant information about the AV-515 A-Code program at the top of the form.
03
Provide the date of the program and its location.
04
Enter the total number of A-Codes assigned for each service at the designated spaces.
05
Calculate the total A-Codes assigned for all services and enter it in the appropriate field.
06
Complete the rest of the form by providing any additional required information about the program.
07
Once all the necessary information is filled, review the form for accuracy and completeness.
08
Sign and date the form to certify its accuracy.
09
Submit the completed AV-515 A-Code Summary form to the relevant authority or department.
Who needs av-515 a-code summary form?
01
The AV-515 A-Code Summary form is typically required by organizations or departments that utilize A-Codes for their services.
02
This form helps in summarizing the information about A-Codes assigned to various services provided by the organization or department.
03
It may be needed by healthcare facilities, government agencies, or other entities that use A-Codes for tracking and reporting purposes.
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