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Rental Application Fee (nonrefundable) is $35.00Date:___ Application to Lease Premises Known As:___ Name of Applicant:___DOB:___/___/___SS #:___ Present Address:___ Years: ___ Own: ___ Rent: ___ Monthly
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It is an online form used for submitting ALS (Advanced Life Support) respite information.
Medical professionals providing ALS respite services are required to file this form.
To fill out the form, the user needs to enter relevant information such as patient details, service provided, duration of respite, etc.
The purpose of the form is to track ALS respite services provided for patients and ensure proper documentation.
Information such as patient name, date of service, type of service provided, duration of respite, and any relevant notes must be reported on the form.
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