Check the appropriate box to indicate whether you have worker’s compensation insurance as required by state law. If applicable, attach proof. If not applicable, check N/A and provide an explanation. 22. “Printed name of provider”—print the last, first, and middle name of the provider as the sole proprietor, partner, corporate officer, or government official when applying to the Department of Health Care Services for enrollment or continued enrollment as a provider in the Medi-Cal program.
DISTRICT COURT STATE OF OHIO NO. CIV. 01-388 JANE WHITE Plaintiff, v. JEFFREY CAULKIN Defendant, v. SAGE RENT-A-CAR, INC. BRIEF IN SUPPORT OF MOTION TO DISMISS QUESTION PRESENTED Under Civil Rule 12(b)(6), Whether a self-insured lessor can still be liable for a lessee’s negligence in an automobile accident? STATEMENT OF CASE Our client, Sage Rent-A-Car, Inc. filed a surety bond with the Registrar of Motor Vehicles and is self-insured under R.C. 4509.72.
United States District Court Division: Northern District Case No: 68-342 IN THE UNITED STATES DISTRICT COURT IN AND FOR THE NOTHERN DISTRICT OF ILLINOIS Justin William King, Plaintiff, vs.Anheuser-Busch, Companies Inc. Defendant. | Case No. : 12192012 ANSWER TO AUTO ACCIDENT COMPLAINT | | | ANSWER TO COMPLAINT COMES NOW, Anheuser Busch, the Defendant, and hereby answers the Plaintiff’s Complaint as follows: I. PARTIES: 1.
LILES v. DAMON CORPORATION (CC 033086; CA A129113; SC S054734) Facts: Before DE MUNIZ, Chief Justice, and GILLETTE, DURHAM, BALMER, KISTLER, and WALTERS, Justices. Gary E. Norman, Albany, argued the cause and filed the brief for petitioners on review. William A. Drew, of Elliott, Ostrander and Preston PC, Portland, argued the cause and filed the briefs for respondent on review. Brian S. Camp, of Brian S. Camp, PC, Portland, filed the brief for amicus curiae Oregon Trial Lawyers Association.
PATIENT CERTIFICATION, CONSENT FOR TREATMENT, AUTHORIZATION TO RELEASE INFORMATION, AND PAYMENT AGREEMENT CERTIFICATION I certify that the information given by me is correct, I authorize [health center name]. DBA [health center name] to release medical or other information about me to Social Security Administration, Medicare Program or its intermediaries or carriers, Medicaid, as well as private insurance claims to the necessary insurance carriers and/or the Professions Standards Review Organization. I request that payment of authorized benefits be made on my behalf. CONSENT FOR TREATMENT I hereby request services from [health center name]. DBA [health center name] and give my consent for the staff to administer and perform medical
What record purpose is associated with each of the following? a. Medical assistant records the height, weight, and vital signs of a patient? Document care /services provided b. The results of the effectiveness of a new drug involved in a clinical research trial are reported to the study coordinator?
KJL Para 101 Summer 2013 JOANN ALEXANDER and JACK ALEXANDER, Appellants (Plaintiffs Below), v. D. KEVIN SCHEID, M.D. and ORTHOPAEDICS INDIANAPOLIS, INC., Appellees (Defendants Below). Indiana Supreme Court Cause No. 49S05-0004-CV-231 SUPREME COURT OF INDIANA 726 N.E.2d 272; 2000 Ind. LEXIS 248 April 3, 2000, Decided PRIOR HISTORY: [**1] APPEAL FROM THE MARION SUPERIOR COURT.
The National Uniform Claim Committee is responsible for the yearly updates of the 1500 (NUCC, 2012); the National Uniform Billing Committee is responsible for the UB-04 (NUBC, 2013). The 1500 is used for services provided by a physician or supplier usually in an office setting, and the UB-04 is used for services provided in a hospital, inpatient or outpatient, or ambulatory surgery centers. * What types of patient information, codes, and insurance information are entered on each of the billing forms? The 1500 and UB-04 require the same types of information: Patient, payer, 2nd payer, addresses; member (patient) and providers ID numbers, type of plan the patient is covered under (ex. Medicare, group health plan), name of patient and DOB of patient receiving services or supplies, provider and payer taxonomy code and area of specialization, diagnosis codes, authorization and place of service codes, date of service, and service providers
Information the scan will return to the officer will include the vehicle owners name, the year the vehicle was made, the make and model, vehicle identification number (VIN), along with the expiration date of the license plate and any suspensions placed on the plate. If the
Shannon Scofield Professor Laurence Mraz Kaplan University PA165: Introduction to torts Unit 6: Memorandum Oct 08, 2012 To: SR. Partner From: Sr. Paralegal Re: John Stockely October 08, 2012 Case: John Stockely v. AAA Auto Dealers Issue: Whether AAA Auto Dealers is vicariously liable for John’s negligence. Facts: John Stockely worked as a sales executive for AAA Auto Dealers. He was given a company car to drive to a manufacturing facility, which is 150 miles from the dealership, to check on new orders. John Stockely was also reimbursed for gas, food and lodging.