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 initial form submitted by you, where such form is designed to enable a determination as to whether your Protein may be a suitable target for Screening, such Intake Form to include at least the Identifying Information of the proposed Provider as well as the name, Uniprot ID, and sequence (including tags) of the Protein proposed to be submitted.
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Examples of Intake Form in a sentence

  • Honeywell may, in its sole discretion, reject a SaaS Order Intake Form or SaaS Order.

  • Contractor’s report (“Initial Report”) shall be provided on that certain Privacy & Incident Intake Form, developed by the Covered California Privacy Office and attached and incorporated by reference herein as Attachment 2.

  • This list will be shared with System Agency through the Smartsheet-based Partnership Directory Intake Form.

  • Adhere to the following additional service delivery requirements: i Document in CMBHS a Withdrawal Management Intake Form.

  • Contractor shall make any and all reasonable efforts to obtain the information requested within the Privacy & Security Incident Intake Form and shall provide an explanation if any information requested cannot be obtained.

  • Pursuant to 28 C.F.R. 35.160(b)(2), the Deaf inmate’s preferred form of Auxiliary Aids and Services as indicated on the inmate’s Intake Form will receive primary consideration.

  • DPSCS, in determining the appropriate Auxiliary Aids and Services to be provided, will consider the request by the Deaf inmate on the inmate’s Intake Form and any input by the Instructor of the class.

  • STUDENT’s with a disability that require accommodation of an emotional support animal must initiate the process for accommodation consideration by completing the Disability Services Center (DSC) Intake Form found at ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/register/.

  • Contractor’s Final Report shall be submitted to the Covered California Privacy Office on the same Privacy & Security Incident Intake Form used for the submission of Covered California’s Initial Report.

  • The Agency shall ensure pavement surfaces are maintained and remain free of residue accumulation, algae, vegetation, and other slip or trip hazards.


More Definitions of Intake Form

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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Intake Form means the primary document by which Borrower submits information on Proposed Projects for review by DOE in accordance with these Validation Process and Procedures, which shall be in the form attached hereto as Annex I to this Schedule 5.04(a), subject to updates by DOE from time to time. Borrower shall submit each Intake Form in accordance with the instructions therein, including all supporting documentation. Submission of notices, forms and information hereunder shall be pursuant to Section 11.04 of the Agreement, except to the extent DOE and the Borrower have agreed in writing to additional or replacement data submission guidelines for purposes of these Validation Process and Procedures, including the adoption of a software tool to facilitate the submission of the Intake Form and supporting documentation.
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Related to Intake Form

  • Database application form means the application form required by the Hibiscus Coast Municipality to be filled in by the successful tenderer, following the award of the contract, for inclusion on the HCM database before payment is made.

  • MEDICAL PRESCRIPTION DRUGS are prescription drugs that require administration (or the FDA approved recommendation is for administration) by a licensed healthcare provider (other than a pharmacist). These medical prescription drugs include, but are not limited to, medications administered by infusion, injection, or inhalation, as well as nasal, topical or transdermal administered medications. Medical prescription drugs are covered as a medical benefit. MEDICALLY NECESSARY (MEDICAL NECESSITY) means that the healthcare services provided to treat your illness or injury, upon review by BCBSRI are: • appropriate and effective for the diagnosis, treatment, or care of the condition, disease, ailment or injury for which it is prescribed or performed; • appropriate with regard to generally accepted standards of medical practice within the medical community or scientific evidence; • not primarily for the convenience of the member, the member’s family or provider of such member; and • the most appropriate in terms of type, amount, frequency, setting, duration, supplies or level of service, which can safely be provided to the member (i.e. no less expensive professionally acceptable alternative, is available). We will make a determination whether a healthcare service is medically necessary. You have the right to appeal our determination or to take legal action as described in Section

  • 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 a sample of blood, tissue or other biological material.