Employee Documents
General employment documents and forms:
- Employee Handbook 2019
- Request for Time Off (to be returned to your immediate supervisor upon completion)
- Release of Protected Health Information (PHI) for Other Purposes and Activities
Printable Chronic Care Management (CCM) forms:
- CCM Correctional Demo Insurance Sheet
- CCM Manual 2017
- CCM Opt-Out Form
- CCM Opt-Out & Opt-In Log Patient Forms for Clinic 2017
- CCM Phone Encounter
- CCM Time Log 2017
- Patient Consent for Chronic Care Services January 2016
The following forms will need to be printed, filled out, and returned to Suzanne Bolton:
The following forms will need to be printed, filled out, and returned to Susan Hall, Human Resources:
- 2017 A-4 Form
- 2017 W-4 Form
- 2017 I-9 Form 2016-2019
- BCBS Dental Ins Application 2016
- BCBS Health Ins Application 2016
- Direct Deposit Agreement Form 2017
- 2017 Employment Application
- 2017 401k Auto Enrollment Notice
- ADA Acknowledgement Form
- 401k Auto Enrollment Acknowledgement Form
- Code of Conduct
- PCI DSS Acknowledgement Form
- PCI DSS Payment Card Industry Data Security Standards
- Coding and Billing Policies and Procedures