Intake Form definition

Intake Form means the checklist used during the student Intake Meeting which ensures the inclusion of behavioral, academic, and other necessary information to facilitate the placement of a student at a Consortium Discipline Alternative Program.
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Intake Form means the form to be used by CHR to gather information regarding, among other things, Patient demographics, referral information, primary and secondary insurance, and physician and medical information.
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Intake Form means the form included in a Deaf inmate’s base file to be provided by DPSCS and completed by all deaf inmates to allow them to select which, if any, Auxiliary Aids and Services they would prefer for all programs, activities, medical appointments and procedures, disciplinary hearings, and all other complex or lengthy communication with prison staff. The name of the Intake Form will be determined upon the creation of an executive directive.
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Examples of Intake Form in a sentence

  • The Letter of Submittal, excluding the signed Certifications and Assurances and Contractor Intake Form, shall be a maximum of one (1) page.

  • The Storm Water Intake Form determines whether a project requires a Standard SWQMP or Priority Development Project (PDP) SWQMP.

  • Bidders shall indicate on their Contractor Intake Form any current or former state employees who are employed by, or subcontracted with, Bidder.

  • Vendors who meet criteria set forth in chapter 39.19 RCW, should completed and submit theBusiness Enterprise Certification Form with the Contractor Intake Form.

  • Self-Certification should be submitted with the Contractor Intake Form (Exhibit D).

  • Utilize OSDBU’s Intake Form to document each small business assisted by the SBTRC and type of service(s) provided.

  • The individualized goals and expectations shall be recorded on the Intake Form.

  • All advertising of homes available will be done through email to those who have completed the Online Intake Form and on the Housing Department website.

  • C.2. LETTER OF SUBMITTAL The Letter of Submittal, the attached Certifications and Assurances, and the attached Contractor Intake Form must be signed and dated by a person authorized to legally bind the Consultant to a contractual relationship, (e.g., the President or Executive Director if a corporation, the managing partner if a partnership, or the proprietor if a sole proprietorship).

  • The online Intake Form can be found on the Housing Department’s website: jhaffordablehousing.org.

Related to Intake Form

  • Slot machine means a mechanical or electronic gambling game device into which a player may deposit currency or forms of cashless wagering and from which certain numbers of credits are awarded when a particular configuration of symbols or events is displayed on the machine.

  • Hospital system means a hospital and one or more

  • Sample means urine, blood, breath, saliva, or hair.

  • Hospital pharmacy means a pharmacy providing pharmaceutical care to

  • Machine gun means any firearm known as a machine gun,

  • Centralized prescription processing means the processing by a pharmacy of a request from another pharmacy to fill or refill a prescription drug order or to perform processing functions such as dispensing, drug utilization review, claims adjudication, refill authorizations, and therapeutic interventions.

  • Prescription drugs means drugs, medicine and controlled substances which by law can only be prescribed for human use by persons authorized by law.

  • Hospital pharmacist means an Iowa-licensed pharmacist who meets the requirements for participating in a hospital practice protocol as determined by the hospital’s P&T committee.

  • Prescription device means an instrument, apparatus, implement, machine,

  • Prototype means a first model or design that has not been produced in batches, and from which the finished cosmetic product is copied or finally developed.

  • Fabrication means making up data or results and recording or reporting them.

  • Dispenser means a practitioner who dispenses.

  • Filter means material placed in the useful beam to preferentially absorb selected radiations.

  • Facsimile (FAX) prescription means a written prescription or order that is transmitted by an electronic device over telephone lines that sends the exact image to the receiving pharmacy in hard copy form.

  • Druggist means any person who holds a valid certificate and

  • Driver means a person who drives or is in actual physical control of a vehicle.

  • Prescription drug means any drug required by federal law or regulation to be dispensed only

  • Acceptance Testing mean the tests, reviews and other activities that are performed by or on behalf of Agency to determine whether the Deliverables meet the Acceptance Criteria or otherwise satisfy the Agency, as determined by the Agency in its sole discretion.

  • Alcohol abuse means any pattern of pathological use of alcohol that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.

  • Radiation therapy simulation system means a radiographic or fluoroscopic x-ray system intended for localizing the volume to be exposed during radiation therapy and confirming the position and size of the therapeutic irradiation field.

  • EPSDT means early and periodic screening, diagnosis, and treatment.

  • Physical therapy aide means a person who has

  • Template means a qualified software solution – based on Software - created by Partner in accordance with the solution qualification guidelines for Software. For details contact your Partner Service Advisor.

  • Prescription monitoring program means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

  • Chip means an integrated circuit embedded in the Card.

  • Physical therapist assistant means an individual who is licensed/certified by a state and who assists the physical therapist in selected components of physical therapy.