Form 13615 Illinois Cook 2024

Form 13615 Illinois Cook: What You Should Know

Download Volunteer Standards of Conduct Agreement — VITA/THE Programs — Illinois Department of State (State).   Download VITA/THE Open Doc. Form (Cook County) Volunteer Standards of Conduct Agreement — VITA/THE Health Care Use of Form 13615: This form provides information on a volunteer's certification. All VITA/THE volunteers (whether paid or unpaid) must pass the  Volunteer Standards of Conduct Agreement — VITA/THE Health Care 12.5 Form 3630.1. Cook County:  Health Care: To be used only for the purpose for which it was issued by the Cook County Board of Trustees. The purpose of this form is to assist Health Care Offices of Public Agencies in determining who the Cook County Volunteer Health Care Team is for the purposes of the Illinois Patient Protection and Affordable Care Act (PACA). The form may be used without a Social Security Number but a valid Social Security Number must be provided for purposes of calculating Medicaid or Medicare or any other federal payment. However, the form must not be used for any other purpose, such as a claim for a refund. The form may be used only for the purposes set forth in the Notice of Voluntary Termination to Volunteer Health Care Team (PDF) issued by the Cook County Board of Trustees effective January 14, 2024 (the “Notice”). The form expires June 15, 2019. The Cook County Board of Trustees reserves the right to amend or remove the notice of termination by the date specified in the Notice. Volunteer Standards of Conduct Agreement — VITA/THE Health Care Use of Form 13615: This form provides information on a volunteer's certification. All VITA/THE volunteers (whether paid or unpaid) must pass the  Volunteer Standards of Conduct Agreement — VITA/THE Health Care 12.6 Application to Volunteer at a Cook County Dental Facility (PDF) Volunteer Standards of Conduct Agreement — VITA/THE Health Care Use of Form 13615: This form provides information on a volunteer's certification.

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