NH Department of Health and Human Services (DHHS) BFA Form 765 Bureau of Family Assistance (BFA) 06/15 rev 2/19 DFA SR 15-15 Return to: Centralized Scanning Unit (CSU), P.O. 2 0 obj ppx~r}^_y~vuqYg=|)x=QT(T]Xmx^~_5]|Wk(f_rs(B,^~]4\! endobj 1193 0 obj <>/Filter/FlateDecode/ID[<8C2304EE3BAA2B4BA51333F619C6E237><6A45965FEF636F41A7C4DDF41080F3DD>]/Index[1170 38]/Info 1169 0 R/Length 111/Prev 271610/Root 1171 0 R/Size 1208/Type/XRef/W[1 3 1]>>stream nRqIP,lK?2|/!.Qf]Sya^>Pec{$h-0e18nr:DQE8O`]fd. 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. Trying to find an office? u3O/KeI^#[Fo/d(\UK5z p?sxF,Czx%[_w44q^TVz8udw"+J>wSw~A('e+S55 2023 Capital Business Systems, Inc. | 800-221-0604, My Account (service, supplies, metering), Architecture, Engineering and Construction, Canon U.S.A. 4]irpmP@;BM'Yp8eV9. 0 1,188 Document Scanning jobs available in Kearny, NJ on Indeed.com. Once the exam begins, you'll lie flat on the CT exam table and sticky electrodes will be adhered to your chest. <> Centralized Intake Bureau Chief, Laura McCullough (406) 444-6849: Centralized Intake Specialist Supervisor, Vacant (406) 444-3286: Centralized Intake Specialist Supervisor, Rachel Rolston (406) 444-9846 The CIT & Authorization mission is to promote and protect public health by: Managing Centralized Intern Training for new agents of the state to become authorized to enforce state sanitation laws and rules. G e8-'hfgJitS\;V:}[|XK[_. {Mi{: {9){E^V-m:RLz#ibY5c0)ysWU5 e5[]y|;[.u7\hit_2f}8|f( oA[i4p28:+;]`lFekVIHh+Z3mS)|IA snZcwh~y['vW! 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. 36T_9?=)^wU(Z^ <> ]k*zrG1uwL=yyrA4hPfen47}`~u[#>k%E{#QQ?xC =Qp 2G#{rY vh%1M,!V t5eZTQ"aT=@yf|3Zo9A B|vqu endobj x]mo7 aiQ"&mmR,&A[#_hH{v#Ky'gtd]|]n? _ ` endstream endobj startxref stream family history of heart disease or heart attack. EAP services are confidential and voluntary to assist NH government employees and their families in addressing issues that may affect their overall well-being. ]G7U2{|^xBhqgL]a|xX"ZDt`1NH PD+kqeXY?0j[cj3@2k4h} rc6f}'WTx`s1]tt\EY_3kH@ip0tKtE=iP ;KN*IF6|,~C,(m l\fq l1I1=Ex>m 2lhY H> E?K-k. Click here for our full COVID-19 response. 1 0 obj 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. S)o vomOM~rO$Op$SM25~V W4:%,U2G|%ru cQSG;Kij"RUNr`#YDz|2)>Fx-#Oo2Zr//,_X'w`t~G:yyk.|PiH4'Z1 ~G/ iy/OPxVe (3YC) Employment Verification (Completed by Employer Only) FROM: Centralized Scanning Unit (CSU) P.O. In addition to specific services directed to individuals, EAP provides consultation services to managers and supervisors effectively addressing group problems or group-focused improvements. BFA SR 19-29 This institution is an equal opportunity provider. \@ 9x i~u x=ko9?4_Ei>XLngs{3AX[Jdd?$[-Q>\R*zr[nvr-/?/l\^z|y&y/_di*,QxY|'/~~Kd KxI!T%>-,BJO/_2TNw1=\]?jrK E>;n:E_HJ>Mo6UBNn % New Hampshire Employment Verification Letter for Social Security If finding legal forms online looks like a problem, use US Legal Forms. Fax: +1 201 455 0151. nyc@scan-shipping.com Box 181 Concord, NH 03301 Eligibility Worker . 1170 0 obj <> endobj '[:?&g=$m (DGP@);]+yFyY|yx3OV 2023 State of New Hampshire All rights reserved, An official NEW HAMPSHIRE government website, www.covid19.nh.gov/resources/treatment-resources, Communication Access & Language Assistance, Alcohol, Tobacco & Other Substance Misuse, Resources for DHHS Providers, Small Business & Nonprofits, Search for programs in the main contact directory. stream 3 0 obj YuLlvLMLyZW*T&2`?! Our free Buyers Guide to Document Management contains more information on scanning, along with other important facts to know about creating a document management system for your business. endobj <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Box 181, Concord, NH 03301 (1YC) Application for Emergency Assistance Name Phone Number Address %PDF-1.6 % <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 4 0 obj When starting off on your search for a scanner, it is important to know the difference between centralized scanning and decentralized scanning. stream Download the form you want from the largest collection of templates. Submit documents that have been requested for your application. While this directory is intended to provide contact information to related programs, it doesn't not include contact information for all DHHS staff members. But for now, here are the differences between centralized scanning and decentralized scanning. Calcium scoring is a fast and painless method of determining a person's risk for heart attack and heart disease. ?L)8h^x3aBGN xQAmdcW2q Box 181 Concord, NH 03301 However, DHHS will not share your health information. ?&8Z{Uh)`&iG-Ipr#TAiRL a0EDc$ '/^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 (o}Wy]vCf \^ [j T*[oD? YsC5 d!GPg$Pk$PkPg$Pk$PkPg$PNT U(;te1dbHO/'Gm]i;_!1W}Lz{=\cWTJ'-SCi]Vi]DGx*X#65:kXa2sn Q=yG*2qtt#BShE EvQvQeIO0p'xmYb=4nll%PkEP2$mIf;dmYicC4begYUQ(ZU@*JV##b`,WE*zWdX;]^/J9'[5nr7Fu$6vR^]hst .tf1=s.7$[\%l\7VJ). Services are available to all NH state government employees and their family members. 2 0 obj 7/2OPcMTvsoDZ)jYJle^VzYdJ]UyU:U%W_U.JQubFMPs0. x TF3e>,YecW=f~+J}VQiIvCYA~,IE`z1Fb2aw(G#&Jv-4m6n} `|UzT4MPjJ5"3t* Calcium scoring is a diagnostic imaging system that uses CT (computed tomography) scans of the coronary arteries to detect the presence of calcified plaque, a substance that builds up inside the artery walls and hardens, making it difficult for oxygen-rich blood to reach the heart. H_K~Dn~"v6 j_O9V) The State of New Hampshire Employee Assistance Program (EAP) is designed to offer assistance to all State employees and their family members. Page 1 of 2. Thank you for your submission. Box 181 Concord, NH 03301 Tenant's name: Tenant's mailing address: Street Apt# City State Zip . <>>> The health and well-being of patients is our primary concern. 1 0 obj U-~H~{(}u:{_/_M=fI$e~fev~Uyv2-3aaaL?Ky9s.2R3 /7 +T*Qa\]ZL 4g9"eO,j]I+Q y~sw =)Ir JJJuRYvsobd <> %PDF-1.5 During calcium scoring, the amount of calcium in the coronary arteries is measured and a score is obtained that can help determine an individual's risk for heart attack or heart disease. Register and get access to reusable templates today! ==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%$U)jDJ":% *%mJZ%:5mJnc(O2 4 0 obj rU}BZyM+]\; ea7PT-@3Dg,.f+63j g$E!`B Abuse & Neglect: (800) 652-1999. New York. Go to the Locations & Facilities page. endobj Box 181 2 0 obj Q\z15b>='w23\K|&6`.lo]2VdITi2-'\NOJL6'o3?nZ. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> <> %PDF-1.5 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 EAP services are confidential and voluntary to assist NH government employees and their families in addressing issues that may affect their overall well-being. NH Department of Health & Human Services (DHHS) DDU Form 177 Bureau of Family Assistance (BFA) - Disability Determination Unit (DDU) rev 12/22 Page: 1 of 9 . <> 2 0 obj <> "3NOVU7GRd3]: q^.I7khxGF:F@u~V(l^yZVo h|-('- 3 0 obj If you test positive for COVID-19 and have symptoms, antiviral medication can help! New Hampshire Employee Termination Form US Legal Forms provides its subscribers with various state-specific legal forms. New Hampshire Employment Verification Letter for Bank With more than 85,000 state-specific editable templates, US Legal Forms guarantees you will find the exact document you need. It is both a confidential and voluntary program, assisting employees and their family members in resolving personal concerns that may interfere with work or home life. NE%Pq8iAwhGRFdWA.;)2U[!I60wEnXqdrO}w;mdL|qyq vsyt>m5N,;'x ; Suicide Prevention: 988. Google Earth Plug-in ONLY operates on Microsoft Windows . Most scans take less than 15 minutes. <>>> <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> NH Department of Health and Human Services (DHHS) BFA Form 756 Bureau of Family Assistance (BFA) 10/19 Thank you for your cooperation. (5N' PgNrj[Wu`F(0^v?Tw|;:y^/_"/a2ke&r?6mBin@\fGt_b_=P6+Jr@%763{@]F0n) mr P%n9mMj+W@t--2{]s$pHqf8.p2f0mlUM`]RUziC7x(;Ls@*VS Securing the data left on that old printer. 4 0 obj 2 0 obj stream Some insurance companies may cover the test as long as you have a doctors referral and preauthorization. 3 0 obj 6\j|CM:.0q=\ .R.HGHm%eeI.L8]kp]@GO2. ).#b NH Department of Health and Human Services (DHHS) BFA Form 775 Bureau of Family Assistance (BFA) 09/22 RENTAL VERIFICATION REQUEST (To be completed by the landlord or Housing Authority, if subsidized.) Centralized Scanning - This is an environment where paper documents are sent to a central location for processing. Concord, NH 03301 @WM7-1.O]d)wXn{Bap\Z-6`7]q){ biB3~K:3l2/a_P{q The electrodes will be attached to an electrocardiograph (ECG) machine which will be used to monitor your heart's electrical signals during the CT scan so images can be made between contractions or beats. During the scan, the CT table will move you slowly through the CT scanning machine, often making several passes to obtain an entire clear series of images. <> <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Federal privacy law says that a form like this one must say that if you sign it and your health information gets shared (disclosed), you should know the information may be shared again (re-disclosed). These scanning can range from personal desktop scanners to production scanners. x]]r8V=H+)\a;}dNtf7lx;SHV}|{|;hEnnv.w7Wgw_HF oUg]?~96}{?xu4|3#.Hu$Dlv{~ ~2l |x=UvK}[D=y?mgSZJF^*c8Q'u(d(]Wm]ZVJ$5$[Wo^4ol%ls |1NUSs:JV6FqR;a~o} Employees and departments participating in the Employee Assistance Program may be concerned about the matter of confidentiality. Types of scanners vary based on your application. Medicaid Assistance: (855) 632-7633. more.. iServe Nebraska . Have a Question About Your Assistance? STATE OF NEW HAMPSHIRE Department of Health and Human Services Division of Economic and Housing Stability Bureau of Child Development and Head Start Collaboration Form 1863 May 2020 BCDHSC Form 1863 May 2020 Mail a copy to DHHS Central Scanning Unit, P.O. &UJ4SpTcn! These services are intended to enhance communication, cooperation, productivity, and teamwork in the workplace. Fax: +1 866 922 4936. lax@scan-shipping.com. ] %U$ 1~fh~n Uv~ @| F?/Ho1zyE@&~^ F?+ygxV Most communications are protected by federal and state laws which assure that whatever information is given, orally or in writing, to any member of the EAP staff will not be revealed. <>>> Explore and apply for benefits. <> %PDF-1.5 }.oWn~zvX,yzqQeiY'RS$*Ks#A=}s4$Tc 1207 0 obj <>stream It is best that you check with your individual insurance plan before scheduling the exam. NH Department of Health and Human Services (DHHS) DFA Form 756 Division of Family Assistance (DFA) 07/07 Rev 8/15 Thank you for your cooperation. Claim this business. ' .GIr!~)H#H?`6h=T4hB \%,dMRU:N 3 Need Help Applying? Main DHHS Switchboard: (402) 471-3121. endobj |Ei=r %&gU/%v2_K?=d)7UL^_i!4?F'(ws/T%qhDBVadZJ%N#l&9$xu}"x.HEuM7$XeVqU`Uy\z>XVu(cxuf-|Kq#njrL5p9o y44 hx*4csBSsR9xFh":fl2mv qH%@9f m'}vlZeZ9RTkCV,4\1\$hZS Diving into the digital world and looking at scanners can prove to be a hassle. Call 1-844-ASK-DHHS (1-844-275-3447) }yB%YFY'j/QRaa O^`"=g/*nxrzdz-TE;BVXG+hi`nW'IbcAf~"KUtGd*tZF~r <> Tel: +1 201 455 0150. The test is more likely to be ordered in men or women with some of the following risk factors: The test can be especially important in determining the cause of unexplained chest pain. NH Department of Health and Human Services DHHS Division of Family Assistance DFA DFA Form 720 02/13 rev 1/15 DETERMINATION OF INCAPACITY STATUS Name Return Completed Form to Centralized Scanning Unit CSU P. How It Works. collector: ethan davio phone: 603-476-2348 #~Q5L76qs%b~:j{Q-AtwLE[sX af Q|cRKQdFej!$o"s~Jcv-RCCHny6$LC3`fac$?mnM;? For information on available treatment in NH, go to www.covid19.nh.gov/resources/treatment-resources. 4 0 obj For information on available treatment in NH, go to www.covid19.nh.gov/resources/treatment-resources, Or look for an answer in our Frequently Asked Questions. When should you upgrade your printer or copier? We at the Employee Assistance Program are committed to confidentiality, however it is important that you realize that even professional confidentiality has its limits. % This buildup of calcified plaque in artery walls is called atherosclerosis, or "hardening" of the arteries. Long Beach, CA 90807, USA. | gZ&)wI,H&-`~YbZ'G~ o+XwH Y_\Ljs. The following tips can help you fill out NH DHHS DFA 756 quickly and easily: Open the document in the feature-rich online editing tool by clicking Get form. 1 0 obj ndfJXN)Z4;B@Jo$Fzp"mfPB %s2!0>|h/KD0.%51~G3|*)L%{gbEpt"*dOhLiF:)-|yGg|]nOI _w[FV__@j#76^_><1Lw =K|4[&W,%?eRo`Z,/^o_&O]0M,0aQvQB>%.|tbX-8)`EMvep !Uf*&VW.=w H}T.MuJZXDVcD1}L-Rl(B)Es:TXJzAka0* jnaR xy:ia+M']Q-M~mFVQ{21~?~&yx"2f Educating and evaluating specialists to ensure that established competency standards are met before they are delegated authority to enforce . Amazon Fulfillment Center-Djz4. b)j In our free Buyers Guide to Document Management, the other types of scanning can be found. Download our free Buyers Guide today or contact us to learn more about how we could help you create a successful document management system for your company! Box 181, Concord, NH 03301 BFA SR 19-29 CentralizedScanUnit@dhhs.state.nh.us (A) ATTESTATION AND VERIFICATION OF SNAP (FORMERLY FOOD STAMPS) HOUSEHOLD DISASTER . 4 0 obj %PDF-1.5 Box 181, Concord, NH 03302 Keep a copy of this form for your records. 5m!$N@or:F&x'ni/@Fs3[4 7g ~K_x 0|O^}Epq|B?~A(Ty`++E IR This buildup of calcified plaque in artery walls is called atherosclerosis, or hardening of the arteries. NH Department of Health and Human Services (DHHS) BFA Form 474 Bureau of Family Assistance (BFA) 10/19 Return this form to: Centralized Scanning Unit (CSU), P.O. endobj There are so many options to choose from, so knowing what you want to get out of your scanner is key. hbbd```b``6@$2,^qA$k*X6L`Y00V/ "OkAd>-`@D% E 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. 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 endobj DHHS has a wide range of programs located in offices across the state. Tel: +1 310 634 0130. An RAI representative will be contacting you shortly. by Capital Business Solutions | Oct 20, 2016 | Blog. endobj 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 . }U-Zwjy'5k7P|X,*!4"\+4s]TE,+;h].jEznQ-jv-]7M=tT 4)/G&FdD%+ RWpb]3 }G~8Y-m)5j@7'023jPCLYI1*mMZg kM$u:)X@*=pg" 3v~=wmnj{cnIX^ G96"g !R The final score will be used by your doctor to assess your heart attack risk and recommend treatment and lifestyle changes when needed. Before the exam, you'll need to remove any jewelry or metal objects including eyeglasses, and you may be asked to put on a hospital gown. You'll be asked to hold your breath at certain points in the scan to move the lungs up and out of the way while images are being made. endobj However, in some cases, the State requires of all individuals the obligation to report certain facts which come to their attention. Scan-Shipping Inc. 590 Belleville Turnpike, Bldg 4, Suite B. Kearny, NJ 07032, USA. 0'Kf(:0W;i~EcqcFH g|d&@EO;H65$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 Most often the answer is no. endobj The EAP works closely with individuals and families to help: EAP Specialists provide professional assessment and referral services to assist employees in developing problem resolution strategies and in linking to community resources. % NH Department of Health and Human Services (DHHS) DFA Form 720 Division of Family Assistance (DFA) 02/13 rev 1/15 DFA SR 13-04 (5YC) DETERMINATION OF INCAPACITY STATUS Name: Return Completed Form to: Centralized Scanning Unit (CSU) Case Number: P.O. <> Introduces Three New Compact A3 Color Models, Analysis of recent cyber-attack statistics. If you test positive for COVID-19 and have symptoms, antiviral medication can help! Fill in the requested boxes which are yellow-colored. V[$&Bb5F$|zt Centralized Intake Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005. x][s8~OU!nJ*If8]S[yPbl"e9_P T;]i Calcium scoring is primarily used for people with specific risk factors for heart attack and heart disease who are considered to have an intermediate risk for having a heart attack in the next decade that is, about a 10 percent to 20 percent chance or slightly more. DFA SR 07-05 (3YC) Employment Verification (Completed by Employer Only) FROM: Centralized Scanning Unit (CSU) P.O. 1 0 obj % % The EAP provides a number of unique services. Adds Six New Printer and Multifunction Devices, Canon U.S.A. When it comes to your business, there are multiple options when it comes to scanning. Scan-Shipping Inc. 4201 N. Long Beach Blvd, Suite 327. An Employee Assistance Program (EAP) is a program that can help with everyday issues to traumatic events. The health and well-being of patients is our primary concern. Box 181, Concord, NH 03301 DFA SR 11-43 (A) REIMBURSEMENT AGREEMENT AND ACKNOWLEDGMENT Applicant Name: Spouse: Name: (Please print) (Please print) . endobj <>>> endstream endobj 1171 0 obj <. BFA SR 22-31 * Forms to be completed for Adult Disability Programs* . Once the scanning procedure is complete, you can resume your regular activities. :.e,"[fNkL+az ;m;^]TD+6*jUT u**Z@ department of health and human services division of economic and housing stability bureau of employment supports 129 pleasant street, concord, nh 03301-3857 603-271-9474 fax: 603-335-5993 tdd access: 1-800-735-2964 www.dhhs.nh.gov participant expectations & commitment name: rid#: (for internal use only). The EAP liberally defines family member to include significant people in the lives of employees. Click on each procedure to learn more. 50 Central Ave Kearny NJ 07032. During calcium scoring, the amount of calcium in the coronary arteries is measured and a score is obtained that can help determine an individual's risk for heart attack or heart disease. W Pc9Ix {8?fj3J1~9TS'! Economic Assistance: (800) 383-4278. Specialist within DHHS, via DHHS's Centralized Scanning Unit, PO Box 181, Concord, NH 03301. <>>> 3 0 obj endobj stream The following procedures are performed by our Interventional Radiology team at designated hospitals. 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. Apply to Medical Technician, Concierge, Document Specialist and more! Also, looking into a maintenance agreement on the scanner can ensure that your scanner will run at . %PDF-1.5 endobj RRH_T|/yEpg0VtPY>'k] The images will be analyzed by the CT scanner software to assess the number of plaques, their density and their distribution so a final calcium score can be determined. endobj Food/Public Accommodations, Jeff Havens, Immunization Information System Training Manager, Vacant, Immunization Information System Interoperability Coordinator, Deb Belleau, Immunization Information System Training & Support, Sarah Lennon, Perinatal Hepatitis B Nurse Consultant, Vacant, Vaccines for Children Quality Specialist, Katie Grady-Selby, Health Education Specialist, Courtney Blaskovich, Financial Specialist,Anthony Littlewhirlwind, STD/HIV Data Entry Specialist, Peggy Baker, Viral Hepatitis Program Manager, Shannon Koenig, STD/HIV Program Evaluator, Brandy Karschnik, HIV/Viral Hepatitis Program Analyst, Gina Tracy, Emergency Management Specialist, Colin Tobin, Health Alert Network Coordinator, Gerry Wheat, Strategic National Stockpile Coordinator, Taylor Curry, ORR Data Specialist/Volunteer Manager, Melissa Burch, Risk Communications Coordinator, Andrea Wingo, Environmental Health Epidemiologist, Abbie Phillip, Environmental Health Assessor, Shuangying Yu, Environment Health Program Specialist, Emma Whitehead, Healthcare Systems Epidemiologist, Vacant, Infection Prevention Specialist, Samantha Carle, Infection Prevention Specialist, Elizabeth Adams, Infection Prevention Specialist, Dianna Bowling, Communicable Disease Nurse Consultant, Jessica Lopeman, Data Acquisition Specialist, Sharon Breidenbach, Adoption/Correction Lead Worker, Mary Suptic, Corrections and Microfilm Clerk, Jenn Rider, Medical Marijuana Lab Sys Improvement Specialist, Kathy Wiegand-Palmer, Medical Marijuana Lab Sys Improvement Specialist, Ian Jacobson, Purchasing/Accounting Tech, Lois Sundblad, Deputy Laboratory Direction/Section Supervisor, Dani Lindeman, Laboratory QA Safety Specialist, Donna Jo Hosmer, Laboratory Data Specialist, Christopher Manning, Micro/Molecular Supervisor, Michelle Mozer, Clinical Laboratory Specialist, Kathy Manion, Clinical Laboratory Specialist, Kelly Barr, Clinical Laboratory Specialist, Ashley Ausman, Clinical Laboratory Specialist, Jaqueline Dixon, Developmental Laboratory Scientist, Joy Ritter, NBS Short-term Follow-up Coordinator, Crystal Fortune, Clinical Lab Specialist, Elizabeth Reynolds, Clinical Lab Technologist, Lorna McIntyre, Clinical Laboratory Specialist, Carla VanderGiessen, Deputy Division Administration, Brandi Loch, Child Abuse Hotline (24 hrs/7 days) Toll Free (In State Only), National Domestic Violence Hotline Toll Free, Grants and Contracts Program Manager, Autumn Beattie, Residential Services Program Officer, Vacant, Chafee Foster Care Independence Program Manager, Elizabeth Bruchez (Lewistown), Centralized Intake Bureau Chief, Laura McCullough, Centralized Intake Specialist Supervisor, Vacant, Centralized Intake Specialist Supervisor, Rachel Rolston, Centralized Intake Specialist Supervisor, Jamie Fortune-Blair, Centralized Intake Specialist Supervisor, Katie Morgan, Centralized Intake Specialist Supervisor, Amanda Morrison, Eastern Region, Miles City, Eric Barnosky, North Central Region, Great Falls, Sahrita Jones-Jessee, North Western Region, Kalispell, Jennifer Blodgett, South Western Region, Butte, Jennifer Hoerauf, Western Region, Missoula, Courtney Callaghan, Administrative Support Supervisor, Angie Smith, Contract Manager, Jo-Anne Rude (Kalispell), Title IV-E Compliance Officer, Lisa Spencer, Title IV-E Compliance Officer, Robet Durrant, Title IV-E Compliance Officer, Cheryl Gran, Title IV-E Compliance Officer, Megan Osborne, Title IV-E Compliance Officer, Cathie Lang, CQI Development Specialist, Sarah Liggett, CQI Development Specialist, Caitlin Stewart-Nurse, Foster Care, Licensing and FRS Bureau Chief, Theresa Becker (Polson), Foster Care & Guardianship Program Manager, Mark Girdler, Permanency Planning Unit Supervisor, Kyla Rock, Adoption Negotiations Manager, Jeanie Weasel Tail, ICPC Deputy Compact Administrator, Lori Hedges, ICPC Deputy Compact Administrator, Kelley Tippett, Post-Adoptions Services Program Manager, Afton Russell, Legal Administrative Support, Janine Whitley, Administrative Support, Gena Geiss-Marton, Main Number - In Helena area or out of state, Employer Relations Specialist, Shawn Rafferty, Federal Tax Offset Specialist, Clarice St Clair, New Hire Directory Specialist, Gary Dahlquist Toll Free, Policy & Procedure Specialist, Jana Maier, Career Development Specialist, Priscilla Hochhalter, Administrative Support, Tanya Mayer-Mlekush, Early Childhood and Family Support Main Number, Early Childhood and Family Support Toll Free Number, Executive Administrative Assistant, Amy McDonald, Child and Adult Care Food Program Toll Free Number, Children's Trust Fund Grant Manager, Joshua Kendrick, Prevention/Early Intervention Program Support, Shari Northcott, Child Care Licensor Anaconda, Michelle Harrington, Child Care Licensor Billings, Ryane Holzwarth, Child Care Licensor Kalispell, Diana Lamers, Child Care Licensor Great Falls, Jodi Linne, Child Carae Licensor Billings, Anna Mason, Child Care Licensor Missoula, Edie McLean, Child Care Licensor Helena, Natalie Mikota, Child Care Licensor Kalispell, Fern Sutherland, Child Care Licensor Bozeman, Teri Whitesitt, Quality Assurance Reviewer, Allison Drake, Child Care Policy and Eligibility Specialist, Chauntel Lucier, Family and Community Health Bureau Administrative Assistant, Kristen Higgins, SRAE and PREP Program Specialist, Jonelle LaPiere, Sexual Assault Prevention & Victim Services, Patrick Paradis, MT Obstetrics Maternal Support Program, Amanda Eby, Title V Maternal, Child Health Block Grant, Blair Lund, Fetal, Infant, Child & Maternal Mortality Review, Kari Tutwiler, Primary Care Office Program Specialist, Annalee Venneri, Outreach & QI Coordinator Program Specialist, Alex Bostrom, Breastfeeding Coordinator Program Specialist, Aimee Duncan, Nutrition Coordinator Program Specialist Lead, Lacy Little, MAPP-NET Program Specialist, Catherine LeMay, Child Care Under the Big Sky, Melody Olson, School Breakfast Coordinator, Linda Cleatus, Communication and Marketing Director, KayAnn Miller, Administrative Support Supervisor, Vena Dagnall, Support Staff Supervisor/MRPO, Kate Miller, Program Manager, Deaf Services, Shawn Tulloch, Transportation Coordinator, Butte, Patrick Sanders, Equipment Distribution Specialist, Missoula, Richard Ballou, Equipment Distribution Specialist, Billings, Mike Bouchard, Assistive Technology Specialist, Paul Suptic, Community Services Program Specialist, Julianna Campbell, CHIMES Security/System Support, Heather Monday, Public Assistance Service Desk / Centralized Scanning Unit Supervisor, Doug O'Dell, Temporary Assistance for Needy Families (TANF) Program Manager, Stephanie Wilkins, Western Region Field Manager, Teri McDonald, Eastern Region Field Manager, Kevin T Frank, Central Region Field Manager, Fred Sullivan, Program Compliance & Training Specialist, Carie Kelly, Commodity Program Specialist, Tina Wagner, Energy & Community Services Program Manager, Marcia Lemon, Energy & Community Services Specialist, Theresa Willard, Energy & Community Services Specialist, Cary Grubb, Energy & Community Services Specialist, Michael Horner, Energy & Community Services Specialist, White Sulphur Springs, Dayna Shepherd, Program Officer, Missoula, Julianna Crowley, Suicide Prevention Coordinator, Karl Rosston, Suicide Prevention Program Specialist, John Tabb, Zero Suicide Grant Manager, Browning, Terrance "TJ" Lafromboise, Prevention Section Supervisor, Kimberly Koch, Mental Health Behavioral Analyst, Deborah Rumberger, Mental Health Eligibility Specialist, Vacant, Special Populations Supervisor, Wyatt McAlpine, Behavioral Health Program Officer, Miranda Griffis, Behavioral Health Program Officer, Missoula, Violet Bolstridge, Program Manager, Missoula, Katie Rasmussen, Medicaid Waiver & State Plan Program Officer, Rena Steyaert, Community Program Officer, Missoula, Jessica Effenberger, Community Program Officer, Miles City, Antonia Klein, Community Program Officer, Missoula, Vacant, Contract and Fiscal Officer, Justin Harris, School Based Services Program Officer, Christine White, Administrative Assistant, Alisha Oellermann, Licensed Clinician, Billings, Anthony Killebrew, Utilization Review Technician, Alana Wilson, Regional Resource Specialist, Helena, Theresa Holm, Regional Resource Specialist, Missoula, Trish Christensen, Medicaid Program Supervisor, Renae Huffman, Grants & Contracts Manager, Stephanie Kindt, Information System Specialist, Chet Williams, Psychiatric Consultant, Dr Michelle McCall, Behavior Consultation Team Supervisor, Connie Orr, Behavior Consultation Specialist, Billings, Cheryl Nystrom, Community Service Supervisor, Shannon Cole-Merchen, Medicaid Program Officer/Transition Specialist, Suzanne Rowe, Medicaid Program Officer/Waiver Specialist, Barbara Doggett, Medicaid Program Officer/Waiver Specialist, Carla Rime, Medicaid Prior Authorization Toll Free Number, Medicaid Transportation Services Toll Free Number, Montana Healthcare Programs Member Helpline, Montana Healthcare Programs Provider Relations Helpline, To Report Medicaid Provider Fraud Toll Free Number, To Report Suspected Medicaid Member Fraud Toll Free Number, Conduent (Montana only) Medicaid Claims Payment Contractor Toll Free Number, IHS/Tribal 638 Program Officer, Jacqui Roberts, Medicaid Operations Research Section Supervisor, Renee Quintana, Medicaid Operations Research Analyst, Vacant, Medicaid Operations Research Analyst, Emily Hollow, Medicaid Operations Research Analyst, Julie Bullman, Medicaid Operations Research Analyst, Trisha Goettle, Allied Health Claims Resolution/DME/Dental, Vacant, Dental & Transportation Program Officer, Lynea Linz, Durable Medical Equipment, Hearing Aid & Audiology Program Officer, Maggie Irby, School Based Services, Optometric, Eyeglasses, Occupational Therapy, Speech Therapy, and Physical Therapy Program Officer, Laurie Nelson, Pharmacy Assistance Supervisor, Christina David, Drug Rebate Program Coordinator, Amber Pierce, Drug Rebate Program Specialist, Shirley 'Michaelanne' Fagnan, Drug Rebate Program Specialist, Ariel Scotton, Hospital Claims Resolution, Amanda Brensdal, Physician Program Officer, Stephanie King, Meadowlark Initiative and PRISM for MOMS Program Officer, vacant, State Plan & Medicaid Waiver, Plan First, WASP, HELP Program Officer, Linda Skiles-Hadduck, Primary Care and Population Health, Passport, CPC+ and PCMH Program Officer, Liz Lelacheur, Healthy Montana Kids Program Officer, Michael Mahoney, Healthy Montana Kids Program Officer, Krista Pratt, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Specialist; Targeted Case Management (TCM Non-Mental Health); Team Care Program, Miranda Prevel, Medicaid Reform Initiative Specialist, Traci Clark, BSW, Adult Protective Services Toll Free Intake Number, Adult Protective Services Region 1 Supervisor, Jody McCampbell, Adult Protective Services Region 2 Supervisor, Sabrina McQuinn, Adult Protective Services Region 3 Supervisor, Janice Hinze, Adult Protective Services Region 4 Supervisor, Glenda Oestreicher, Director, State Unit on Aging, Kerrie Reidelbach, State Long term Care Ombudsman Program Manager, Carmen Sciabica, State Health Insurance and Assistance Program Director, Janet Stellmon, Program Manager, Michael Woods (Great Falls), Program Manager, Michaelene 'Micky' Brown, Facility Based Section Supervisor, Derik Sapp (Great Falls), Financial Technical Analyst, Samantha Cooley, Financial Transparency Specialist, Monique England, Montana Mental Health Nursing Care Center and Intensive Behavior Center Financial Investigator, Daryl Hickey, Montana Chemical Dependency Center and Montana Veterans Home Financial Investigator, Peggy Bennetts, Montana State Hospital Financial Investigator, Calvin Trainor, Montana State Hospital Financial Investigator, Krista Henderson, Logistics Coordinator - Mail, Tim Isaacson, Logistics Coordinator - Mail, Chris Herman, Logistics Coordinator - Surplus, Don Bartsch, Logistics Coordinator - Surplus, Brian Johnson, Accounting Technician, Dustin Hendrickson, Records and Lease Specialist, Theresa Rush, AR & Internal Control Specialist, Beth Lewis, Accounting Technician (Med Needy), Emma Frydenlund, Life Safety Code, Emergency Preparedness, CLIA Supervisor Tony Sanfilippo, Health Facility Surveyor, Rachelle Jewison, Health Facility Surveyor, David J. Rankosky, Acute & Continuing Care /Complaint/Dispute Resolution Manager, Tyler Smith, Health Facility Surveyor, Jennifer Anderson, Nursing Facilities Abuse Hotline Toll Free Number, Healthcare Facility Program Manager, Tara Wooten, Residential Care Program Manager, Anaconda, Julie Fink, Residential Care Licensing Surveyor, Bryan Greer, Residential Care Licensing Surveyor, Stephanie Galle, Residential Care Licensing Surveyor, Christopher Sowell, Residential Care Licensing Surveyor, Sabrina Charlson, Residential Care Licensing Surveyor, Teresa Burtell, Residential Care Licensing Surveyor, Kara Seyer, Payment Error Rate Measurement (PERM), Shauna Longmire, Quality Control Team Lead, Heather Kerker, Quality Control Auditor, Kristyn Anderson, Quality Control Auditor, Ashley Alexander, IPV/ MEQC / PERM Supervisor, Heather Smith, Program Integrity Specialist, Christen LeBlanc-Birkholz, Program Integrity Investigator, Yvonne Perry, Program Integrity Investigator, Lana Madsen, Program Integrity Investigator, Nancy White, Program Integrity Investigator, Cassie Cable, Lead Program Integrity Compliance Specialist, Jennifer Bergmann, Program Integrity Compliance Specialist, Summer Roberts, Program Integrity Compliance Specialist, Vacant, Program Integrity Compliance Specialist, Jamie Larsen, Program Integrity Compliance Specialist, Alyssa Clark, Program Integrity Compliance Specialist, Ross Barnes, Program Integrity Compliance Specialist, Rachel Savage, TPL Tort Recovery Officer, Shawn Ratchford, Security & Compliance Manager, Jackie Thiel, Information Security Analyst, Thomas Somerville (Shane), Information Security Analyst, Michael De La Torre, Lead Computer Application Engineer, Marty Wangen, Computer Application Engineer, Great Falls, Vacant, Computer Application Engineer, Shane Echo, Computer Application Engineer, Sasha Harlow, Computer Application Engineer, John Monday, Computer Application Engineer, Paul Nagel, Training Development Specialist, Erica Graham, Network Systems Analyst, Billings, Jesse Hartmann, Network Systems Analyst, Kathleen Kershaw, Network Systems Analyst, Scott Pomajevich, Computer Security Engineer, Sherry Mitschke, Computer Security Engineer, Jarrod Lindseth, Computer Security Engineer, Casey McMahon, Computer Security Specialist, Sheldon Kaldor, Computer Security Specialist, Joseph Hudson, Computer Support Specialist, Robert Markovich, Computer Support Specialist, Shawn Schreiber, STATE MOTTO: ORO Y PLATA (GOLD AND SILVER), Public Health and Human Services, Department of. 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