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PART TIME HEALTHCARE PROVIDER CREDIT APPLICATION Instructions: 1. 2. Sign and date this form and fax to the SCJ UA. You may use this page as a fax cover sheet. Name of practice contact person requested
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Write the current date in the format specified by the document. Common formats include month/day/year or day/month/year.
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As for who needs to sign and date this document, it depends on the specific context or purpose of the document. In general, the individuals who need to sign and date a document are usually the parties involved or affected by its content. This may include individuals involved in a contractual agreement, legal documents, consent forms, or any situation where formal acknowledgment or authorization is necessary. It is important to review the document's instructions or consult with the relevant parties to determine who should sign and date it.
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Sign and date this refers to the act of putting one's signature and the current date on a document.
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To fill out sign and date this, simply write your signature and the current date on the designated spaces provided.
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