Medical Treatments. The Centre does not support Projects promoting or resulting in the promotion of medical treatments that are not sanctioned as safe and efficacious in accordance with recognized national and international standards. The Recipient will not, during the course of this Project or through activities arising from it, recommend the use of medical treatments that do not meet these standards.
Medical Treatments. Did you see a doctor or other medical provider related to your hair loss and/or scalp irritation? If yes, complete this section. If not, continue to the next step. Yes No Under the terms of the Settlement, you may be reimbursed for any out-of-pocket expenses you incurred as a result of the hair loss or scalp irritation. However, PROOF OF PAYMENT IS REQUIRED for reimbursement, such as receipts, cancelled checks, bank statements, account statements, etc. Medical payments covered by insurance will not be reimbursed. Co-pay or out-of-pocket medical payments related to hair loss or scalp irritation qualify for reimbursement. Payments made by your insurance company are not recoverable. In the section below (starting on page 11), list your out-of-pocket expenses for medical treatments, approximate date of payment and to whom payment was made. Attach the corresponding documentation to your Claim Form. Please attach an additional sheet if you have additional expenses. If you need additional space, please additional sheets as necessary. If some of your expenses were paid by insurance or otherwise reimbursed, please indicate below. QUESTIONS? Visit the settlement website at xxx.XxxxxXxxxXxxxxxxxxx.xxx or call 0-000-XXX-XXXX *DVCFIVE* Date Amount Paid Proof attached? $ . Yes No Name of Provider Description of Services Address City State Zip Code Phone Number Type of Provider Primary care physician/family doctor Dermatologist Specialist Psychiatrist Therapist Other Name of Insurance Provider Member ID Plan Number Group Number Diagnosis Telogen Effluvium (temporary hair loss) Thyroid disease Alopecia areata Hereditary hair loss Scarring alopecia Cancer treatment Hormonal imbalance Syndrome (PCOS) Scalp infection Medication side effects Scalp Psoriasis Deficiency of iron, biotin, protein, or zinc Major psychological stress Abrupt hormonal changes (including those associated with childbirth and menopause) QUESTIONS? Visit the settlement website at xxx.XxxxxXxxxXxxxxxxxxx.xxx or call 0-000-XXX-XXXX *DVCSIX* Date Amount Paid Proof attached? $ . Yes No Name of Provider Description of Services Address City State Zip Code Phone Number Type of Provider Primary care physician/family doctor Dermatologist Specialist Psychiatrist Therapist Other Name of Insurance Provider Member ID Plan Number Group Number Diagnosis Telogen Effluvium (temporary hair loss) Thyroid disease Alopecia areata Hereditary hair loss Scarring alopecia Cancer treatment Hormonal imbalance Syndrome (PCOS) Scalp...
Medical Treatments. Owner represents that pet is healthy and has not been exposed to any known communicable disease within a thirty day period prior to boarding. The owner shall disclose elsewhere on this contract all known medical conditions and/or behavior problems, which may affect the pet’s care. It is the Owner’s responsibility to inform HPH of any changes in the pet’s condition for all subsequent boarding stays.
Medical Treatments. If prescribed Note: Some items that have been added will be deemed as taxable benefits and will show as such on your T4 BETWEEN: XXXXXX TRANSPORT LTD. AND: TRANSPORT, MARINE, WAREHOUSING AND ALLIED WORKERS UNION, CLAC LOCAL 66
