Application Download Area

To download the following forms choose one of the following:

  1. Right Click Icon > Save Target As
  2. Left click Icon > Open Document > File > Save As

 

Appointment Application Checklist
File Name:LAC_Appointment_Application_CheckList.doc
Appointment Application Checklist MAIN
File Name: LAC_Appointment_Application_MAIN.doc
DHS Data Security
File Name: LAC_DHS_Data_Security_935.doc
EMTALA
File Name: LAC_EMTALA3.doc
HIPAA Privacy and Security Study Guide
File Name: LAC_HIPAA_Privacy_and_Security_StudyGuide_rev_110805_MAIN.doc
Letter of Recommendation
File Name: LAC_Letter_of_Recommendation_Revised09-15-07_MAIN.DOC
List for Hospital Affiliations
File Name: LAC_List_for_HospitalAffiliations.doc
Medicare Acknowledgement Statement
File Name: LAC_Medicare_AcknowledgementStatement.doc
Medicine LAC
File Name: LAC_Medicine_LAC_Revised_4_2002.doc
Tuberculousis Screening Acknowledgment MAIN
File Name: LAC_Tuberculousis_ScreeningAcknowledgment_MAIN.DOC
   
   

 

 

 

 

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