family history of heart disease or heart attack. }G~8Y-m)5j@7'023jPCLYI1*mMZg kM$u:)X@*=pg" 3v~=wmnj{cnIX^ G96"g !R endobj x][s8~OU!nJ*If8]S[yPbl"e9_P T;]i U-~H~{(}u:{_/_M=fI$e~fev~Uyv2-3aaaL?Ky9s.2R3 /7 +T*Qa\]ZL 4g9"eO,j]I+Q y~sw =)Ir JJJuRYvsobd T_'NlXZ\^VUM=xO]R":ug5z/%91x^W[?Jhc Q !, Q0u`J)Ea@Dp1 iBqdEuzt{J~T6 k1F6Qbv*jyGP9H)Te+fSCKiP}MDe_|PC}`XH'[C4k+^\^0i3t9P3Y4 syf`^LGC gd8!r;WTc,7:!(OWf@6 !d^ F%="!4gF` guiHO*U66vC7(.EcSMx>Z+e7L"0aQ However, in some cases, the State requires of all individuals the obligation to report certain facts which come to their attention. While this directory is intended to provide contact information to related programs, it doesn't not include contact information for all DHHS staff members. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> When it comes to your business, there are multiple options when it comes to scanning. ]k*zrG1uwL=yyrA4hPfen47}`~u[#>k%E{#QQ?xC =Qp 2G#{rY vh%1M,!V t5eZTQ"aT=@yf|3Zo9A B|vqu A family member is extended the same rights of confidentiality as the employee, and of course, the program is voluntary for family members as well. Our free Buyers Guide to Document Management contains more information on scanning, along with other important facts to know about creating a document management system for your business. These scanning can range from personal desktop scanners to production scanners. YuLlvLMLyZW*T&2`?! Amazon Fulfillment Center-Djz4. By law, the EAP staff must notify appropriate agencies of: We are committed to the principle that any information or material we receive, other than that required by law to be reported to authorities will not be communicated to anyone without your permission. % NH Department of Health & Human Services (DHHS) DFA Form 65 Division of Family Assistance (DFA) 11/01 Rev 3/2011 rev2 3/15 DFA SR 01-36 (3YC) Client's Printed Name Date Client's Case Number CLIENT STATEMENT Shelter Statement Fraud Statement Voluntarily Withdrawing Application Voluntarily Terminating Fax: +1 866 922 4936. lax@scan-shipping.com. % &UJ4SpTcn! The health and well-being of patients is our primary concern. hb```UB2B eadh ^cPjixHQu%-\J1``h``` R0,* d`.EX, I-$?oLMKs73c!F00_yl Vl9 endobj You'll be asked to hold your breath at certain points in the scan to move the lungs up and out of the way while images are being made. #~Q5L76qs%b~:j{Q-AtwLE[sX af Q|cRKQdFej!$o"s~Jcv-RCCHny6$LC3`fac$?mnM;? h!aYL\>x"LEzX^GR4*{,:B L%H}39S?|J>}^K%i^ _gt3|4\~LN>?_+4OWdT2\&+N;9P%h,@"j{9648oGL ~juV$y$7kX`4#{%?'fvazwr&yy?oc17k Dx/c1l R4]E fAZ>_'9qk5'?:%P2IwU?!0 l$}Mi|0=,Q0t}ns=6\N9J\ u7KGAD]NE6n v-%,#M(T40yJU +SOpG`04TJ*)-L,+o:"[p9aB V=k`0vyiBQn&+Bgj=kXpc>I V94X/50f v@C' LYn.b19 7"Gy4! <> NH Department of Health and Human Services (DHHS) DFA Form 770 Estate Recoveries Unit/Division of Family Assistance (DFA) 11/11 rev 1/15 rev2 9/16 Return to: Centralized Scanning Unit (CSU), P.O. EAP services are confidential and voluntary to assist NH government employees and their families in addressing issues that may affect their overall well-being. Introduces Three New Compact A3 Color Models, Analysis of recent cyber-attack statistics. Before the exam, you'll need to remove any jewelry or metal objects including eyeglasses, and you may be asked to put on a hospital gown. endobj Download the form you want from the largest collection of templates. Google Earth Plug-in ONLY operates on Microsoft Windows . NH Department of Health and Human Services (DHHS) BFA Form 756 Bureau of Family Assistance (BFA) 10/19 Thank you for your cooperation. Once the scanning procedure is complete, you can resume your regular activities. When calcified plaques occur in the coronary arteries, the condition is called coronary artery disease, or CAD, which is a leading cause of heart attack and death. An Employee Assistance Program (EAP) is a program that can help with everyday issues to traumatic events. 7/2OPcMTvsoDZ)jYJle^VzYdJ]UyU:U%W_U.JQubFMPs0. 0'Kf(:0W;i~EcqcFH g|d&@EO;H65$D_$@F\7v*$ ISb\}]lXHPPm?.W;Ez'"NC6[B$!"/}Ys+DiW(xjnc[k;-:4!C[S .^8\xqn\ -3vGnJ` &8~"Hz`Qg:Z[9I(di_oHlWtd8C1XqRwl!goNrpB+o@IkCA/9OM=Uu%PW\-RPyV`eJe z1~_9AQwet]*clH"[^gD2 LXmVgXRAk]U:=QOO|yjwGSg{e`)*44'-lSTiTG!H1RJVe$3/o"kE@SOkK@eq;IMYF1D&|z@cDBUsgaf{1*Q'e=4kTh#1\T,UR5ni+pmz; Uy~*6\=[Q{6aLXjBGpBsVB};Zn\Rt/$_jDw ]1VZgv*8ukN0|[J:C$aX/+B`%1vKQT 7DWg[X4018l_pEfH(y%|}$OW+GN6>k=gsh{VR8o_Q?]%8.\5]zr5.BPrv1I;ohu1TvHzUM&t+S6AK94]X:Pi2& `WKOMDAV67\b9>qV;Ph*3o,yv87B"|a5N*L&^!&>ai 1 0 obj %U$ 1~fh~n Uv~ @| F?/Ho1zyE@&~^ F?+ygxV 3 0 obj Abuse & Neglect: (800) 652-1999. ?&8Z{Uh)`&iG-Ipr#TAiRL a0EDc$ '/^B0CD4m~^E!z&RdZM0#R'~#0`LQBfI,Ypm@ow:ki[G.o)Z\qB]htt[mK#3}1A"ebW2K = rdLdd[;r9*2c\CGHca41`f%#4nu6'y(ct[i{L^xO`[?zX4>ar~aqe~a%I#Xx6>1>jHMY?Mj=!1C%D&\ciLi+q'>ZQe7cS:A;.uSjJhp#L*.!QzvLwY~Y I*_mKi~C>',=K&+I;m/6apl$-G?.\u_-G6vw\_` feC6KGjXC r`|{}_@3v@tlFAu 0~asbJUk.xU$V[diJY?.X~~2f(^+w5M_Ngf`bLBoCxGAt `cj \9QJ endstream endobj 1171 0 obj <. Intake Procedure (1) Children and young adults in families who are already receiving SNAP do not need to apply, the benefits will be loaded onto their LINK/EBT card automatically, (2) Apply online at ABE.illinois.gov, or fill out the paper application by downloading it from the IDHS website and emailing the completed form to DHS.FCS.PEBT@illinois.gov, (3) Completed application forms can also . TO: FROM: Centralized Scanning Unit P.O. Have a Question About Your Assistance? 2 0 obj S)o vomOM~rO$Op$SM25~V W4:%,U2G|%ru cQSG;Kij"RUNr`#YDz|2)>Fx-#Oo2Zr//,_X'w`t~G:yyk.|PiH4'Z1 ~G/ iy/OPxVe Box 181, Concord, NH 03301 (1YC) Application for Emergency Assistance Name Phone Number Address Specialist within DHHS, via DHHS's Centralized Scanning Unit, PO Box 181, Concord, NH 03301. 3 0 obj Centralized Intake Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005. New York. Centralized Scanning - This is an environment where paper documents are sent to a central location for processing. '[:?&g=$m (DGP@);]+yFyY|yx3OV stream W Pc9Ix {8?fj3J1~9TS'! endobj stream Choose from 85,000 state-specific document templates available for download in Word and PDF format. Scan-Shipping Inc. 4201 N. Long Beach Blvd, Suite 327. When calcified plaques occur in the coronary arteries, the condition is called coronary artery disease, or CAD, which is a leading cause of heart attack and death. 5m!$N@or:F&x'ni/@Fs3[4 7g ~K_x 0|O^}Epq|B?~A(Ty`++E IR Scan-Shipping Inc. 590 Belleville Turnpike, Bldg 4, Suite B. Kearny, NJ 07032, USA. NE%Pq8iAwhGRFdWA.;)2U[!I60wEnXqdrO}w;mdL|qyq vsyt>m5N,;'x ; Register and get access to reusable templates today! Services are available to all NH state government employees and their family members. Fax: +1 201 455 0151. nyc@scan-shipping.com ==c a41j01P F!+dPP;)\1iU2hSB_On)/JTa1"BL$CJG ZSv ,M0_9*mmMHd6uCm+jE":E@HVQP(U * jr-pKVI$HV $$Qm%H+&58O^AS,As*F%$U)jDJ":% *%mJZ%:5mJnc(O2 stream %%EOF 111 North Sanders Helena, MT 59601-4520 PO Box 4210 Helena, MT 59604-4210, 1400 Broadway, Rm C314, Helena, MT 59601-5231, Asthma and Diabetes Prevention and Control Programs, Nutritional and Physical Activity Program, 1400 Broadway, Room C202 Helena, MT 59601-5231 TOP, 1400 Broadway, Room B102 Helena, MT 59620, 1400 Broadway, Room C216 Helena, MT 69601-5231, 1400 Broadway, Room C216 Helena, MT 59601, Program Planning Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005 TOP, Centralized Intake Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005, 1625 11th Ave, Helena MT 59601 PO Box 4210, Helena MT 59620, 1625 11th Ave, Helena MT 59601 PO Box 4210, Helena MT 59620 TOP, Food Distribution/Commodity Warehouse Program 1400 Carter Drive, Helena, MT 59601-6400 PO Box 202956, Helena MT 59620-2956 TOP, Energy & Community Services Program (LIEAP & Weatherization) 1400 Carter Drive, Helena, MT 59601-6400 PO Box 202956, Helena, MT 59620-2956 TOP, Medicaid & Healthy Montana Kids Drug Rebate Program, 1400 Broadway, Room A104 Helena, MT 59601-5231, Audit Bureau 2401 Colonial Dr, 3rd Floor Helena, MT 59601-4909, Administrative Support Supervisor,Afrah Al Asadi, Administrative Assistant,Andrew Erickson, 1100 N. Last Chance Gulch, 2 nd Floor, Helena, MT 59601 TOP, State Information Technology Services Division PO Box 200113 Helena, MT 59620-0113 CONTACT US, STD DIS Program Specialist, Miranda Reddig, U.S. BUREAU OF LABOR STATISTICS FOR MONTANA, MONTANA OFFICE OF TOURISM AND BUSINESS DEVELOPMENT, MONTANA HISTORICAL SOCIETY RESEARCH CENTER, Behavioral Health and Developmental Disabilities, Office of Inspector General (formerly Quality Assurance), State Information Technology Services Division, Economic Security Services Executive Director, Erica Johnston, Medicaid and Health ServicesExecutive Director, Mike Randol, Medicaid and CHIP State Plan Amendment and Waiver Coor., Mary Eve Kulawik, Strategic Planning, Research andAnalysis, Eric Higginbotham, Operations Revenue Forecasting Specialist, Jamie Bartole, Office of Inspector General, Michelle Truax (Interim), State Medical Officer, Dr. Maggie Cook-Shimanek, Office of Health and Human Services Innovation, CIO, Marie Matthews, Legislative and Regulatory Affairs, Brenton Craggs, Communications Specialist, Herbert Council, Program Analyst/Technical Writer, Megan Grotzke, Faith and Community Based Services, Tracy Moseman, American Indian Health Director, Stephanie Iron Shooter, Chief Human Resources Officer, Karol Anne Davis, Deputy Human Resources Officer, Ciarra Krantz, Civil Rights and EEO Officer , Lloyd Sparks, Senior Human Resource Partner/Employee & Labor Relations, Sarah Green, Senior Human Resource Partner/Facility Liaison, Vacant, Human Resources Office Coordinator, Sam Askin, Risk Management and Safety Officer, Joe McAnally, Occupational Health and Safety Officer, Tawni Jo Carmody, Deputy Chief Legal Counsel, Chad G. Parker, Attorney, HIPAA Program Officer, Theran Fries, Office Manager / Administrative Rule Specialist, Valerie St. Clair, Administrative Rule Specialist, Kassie Thompson, Administrative Legal Assistant, Bailey Yuhas, Medicaid Systems Operations Manager, Shellie McCann, State MedicalDirector, Dr. Maggie Cook-Shimanek, MD, Local & Tribal Support Coordinator, Kerry Pride, DVM, System Improvement Coordinator, Terry Ray, Public Health Accreditation Coordinator, Vacant, Workforce Development Coordinator, Neva Loney, Performance Management and Information Systems Coordinator, Marilyn Trevino, State Refugee Coordinator, Kathe Quittenton, Epidemiology Program Manager, Heather Zimmerman, Office Manager/Financial Specialist, Jodee Prevel, Disability Health Education Specialist, Mackenzie Jones, Office Manager/Financial Specialist, Susan Day, Administrative Specialist, Carolyn Linden, Determinates of Health Program Manager, Margaret Mullins, Secondary Prevention Specialist, Mike McNamara, Quality Improvement Coordinator, Callan Brick, Asthma Control Program Manager, BJ Biskupiak, EMS Licensing and PI Specialist, Francine Janik, Cardiac Ready Program Manager, Janet Trethewey, Community Integrated Health Program Specialist, Kelly Little, Trauma System Manager, Alyssa Johnson, RN, BSN, Violent Death Registry Program Manager, William "Buck" Herron, Injury Prevention Coordinator, Maureen Ward, Health Education Specialist, Alivia Winters, Administrative Support/Licensing, Sandra Tirrell, Body Art/Trailer Court Camp Grounds/ Cottage Food/ Farmers Markets, Mark Hall, Wholesale Mfg. 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dhhs centralized scanning unit