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PRINTED: 08/26/2016 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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To fill out the Good Samaritan form in Pontiac, follow these steps:
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Obtain a Good Samaritan form from the appropriate authority or download it from their website.
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Provide your personal information, including your name, address, phone number, and email address.
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Provide details about the incident or event where you provided assistance as a Good Samaritan.
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Describe the nature of the assistance you provided and mention any medical or first aid procedures performed.
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Include any additional relevant information that may be required, such as witnesses present or any damages or injuries involved.
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Sign and date the form to certify the accuracy of the provided information.
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Submit the completed form to the designated authority or organization.

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Anyone who has witnessed or been involved in an emergency situation where they provided assistance as a Good Samaritan in Pontiac may need to fill out the Good Samaritan form. This includes individuals who have administered first aid, offered help at accident scenes, or provided medical assistance in emergency situations. It is important to fill out the form to document the details of the incident and protect both the Good Samaritan and the person receiving assistance.
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Good Samaritan - Pontiac is a program that provides legal protection to individuals who voluntarily give assistance to those who are injured or in peril.
Individuals who provide assistance in good faith, without expecting payment in return, are required to file Good Samaritan - Pontiac.
Good Samaritan - Pontiac forms can be filled out by providing details of the assistance provided, along with personal information.
The purpose of Good Samaritan - Pontiac is to encourage individuals to help others in need without fear of legal repercussions.
The information reported on Good Samaritan - Pontiac includes the nature of the assistance provided, the location, and the identities of both the helper and the recipient.
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