Click on each procedure to learn more. The following tips can help you fill out NH DHHS DFA 756 quickly and easily: Open the document in the feature-rich online editing tool by clicking Get form. Have a Question About Your Assistance? endstream endobj startxref The health and well-being of patients is our primary concern. Hit the green arrow with the inscription Next to move on from one field to another. endobj % An RAI representative will be contacting you shortly. Once the exam begins, you'll lie flat on the CT exam table and sticky electrodes will be adhered to your chest. Click here for our full COVID-19 response. U-~H~{(}u:{_/_M=fI$e~fev~Uyv2-3aaaL?Ky9s.2R3 /7 +T*Qa\]ZL 4g9"eO,j]I+Q y~sw =)Ir JJJuRYvsobd While this directory is intended to provide contact information to related programs, it doesn't not include contact information for all DHHS staff members. 1 0 obj 2023 State of New Hampshire All rights reserved, An official NEW HAMPSHIRE government website, www.covid19.nh.gov/resources/treatment-resources, Communication Access & Language Assistance, Alcohol, Tobacco & Other Substance Misuse, Resources for DHHS Providers, Small Business & Nonprofits, Identify issues before they disrupt your personal or professional life, Improve an employee's ability to carry out his/her job, Any form of neglect or abuse to children or the elderly, Posing a threat of harm to self or others. (5N' PgNrj[Wu`F(0^v?Tw|;:y^/_"/a2ke&r?6mBin@\fGt_b_=P6+Jr@%763{@]F0n) mr P%n9mMj+W@t--2{]s$pHqf8.p2f0mlUM`]RUziC7x(;Ls@*VS % Scan-Shipping Inc. 590 Belleville Turnpike, Bldg 4, Suite B. Kearny, NJ 07032, USA. W Pc9Ix {8?fj3J1~9TS'! 3 0 obj In our free Buyers Guide to Document Management, the other types of scanning can be found. Call 1-844-ASK-DHHS (1-844-275-3447) @WM7-1.O]d)wXn{Bap\Z-6`7]q){ biB3~K:3l2/a_P{q endobj 4 0 obj }.oWn~zvX,yzqQeiY'RS$*Ks#A=}s4$Tc Choose from 85,000 state-specific document templates available for download in Word and PDF format. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The EAP provides a number of unique services. % ]G7U2{|^xBhqgL]a|xX"ZDt`1NH PD+kqeXY?0j[cj3@2k4h} rc6f}'WTx`s1]tt\EY_3kH@ip0tKtE=iP ;KN*IF6|,~C,(m l\fq l1I1=Ex>m 2lhY H> E?K-k. u3O/KeI^#[Fo/d(\UK5z p?sxF,Czx%[_w44q^TVz8udw"+J>wSw~A('e+S55 h!aYL\>x"LEzX^GR4*{,:B L%H}39S?|J>}^K%i^ _gt3|4\~LN>?_+4OWdT2\&+N;9P%h,@"j{9648oGL ~juV$y$7kX`4#{%?'fvazwr&yy?oc17k Dx/c1l R4]E fAZ>_'9qk5'?:%P2IwU?!0 l$}Mi|0=,Q0t}ns=6\N9J\ u7KGAD]NE6n v-%,#M(T40yJU +SOpG`04TJ*)-L,+o:"[p9aB V=k`0vyiBQn&+Bgj=kXpc>I V94X/50f v@C' LYn.b19 7"Gy4! <> H_K~Dn~"v6 j_O9V) Box 181, Concord, NH 03302 Keep a copy of this form for your records. The images will be analyzed by the CT scanner software to assess the number of plaques, their density and their distribution so a final calcium score can be determined. Need Help Applying? &UJ4SpTcn! x=ko9?4_Ei>XLngs{3AX[Jdd?$[-Q>\R*zr[nvr-/?/l\^z|y&y/_di*,QxY|'/~~Kd KxI!T%>-,BJO/_2TNw1=\]?jrK E>;n:E_HJ>Mo6UBNn 2 0 obj stream Our free Buyers Guide to Document Management contains more information on scanning, along with other important facts to know about creating a document management system for your business. 1 0 obj <> These services are intended to enhance communication, cooperation, productivity, and teamwork in the workplace. <> 3 0 obj 2 0 obj Concord, NH 03301 The State of New Hampshire Employee Assistance Program (EAP) is designed to offer assistance to all State employees and their family members. ?L)8h^x3aBGN xQAmdcW2q i. STATE OF NEW HAMPSHIRE Department of Health and Human Services Division of Economic and Housing Stability Bureau of Child Development and Head Start Collaboration Form 1863 May 2020 BCDHSC Form 1863 May 2020 Mail a copy to DHHS Central Scanning Unit, P.O. An Employee Assistance Program (EAP) is a program that can help with everyday issues to traumatic events. The EAP liberally defines family member to include significant people in the lives of employees. Diving into the digital world and looking at scanners can prove to be a hassle. You'll be asked to hold your breath at certain points in the scan to move the lungs up and out of the way while images are being made. Main DHHS Switchboard: (402) 471-3121. <> q^.I7khxGF:F@u~V(l^yZVo h|-('- Box 181, Concord, NH 03301 (1YC) Application for Emergency Assistance Name Phone Number Address Most scans take less than 15 minutes. x}o7?$s{Cd--644zh=)4EUz?>^/.=^>ybyu?~8_|^vWfW_}V8{OO_9/r+|fO\.B\Wo9N>>'_ 4 0 obj Adds Six New Printer and Multifunction Devices, Canon U.S.A. Abuse & Neglect: (800) 652-1999. BFA SR 22-31 * Forms to be completed for Adult Disability Programs* . We are proud to offer this exam for the everyday price of $79. Fill in the requested boxes which are yellow-colored. Q\z15b>='w23\K|&6`.lo]2VdITi2-'\NOJL6'o3?nZ. Suicide Prevention: 988. Before the exam, you'll need to remove any jewelry or metal objects including eyeglasses, and you may be asked to put on a hospital gown. Calcium scoring is primarily used for people with specific risk factors for heart attack and heart disease who are considered to have an intermediate risk for having a heart attack in the next decade that is, about a 10 percent to 20 percent chance or slightly more. (o}Wy]vCf \^ However, DHHS will not share your health information. Download the form you want from the largest collection of templates. 0 <>>> NH Department of Health and Human Services (DHHS) DFA Form 756 Division of Family Assistance (DFA) 07/07 Rev 8/15 Thank you for your cooperation. 0'Kf(:0W;i~EcqcFH g|d&@EO;H65$D_$@F\7v*$ ISb\}]lXHPPm?.W;Ez'"NC6[B$!"/}Ys+DiW(xjnc[k;-:4!C[S .^8\xqn\ -3vGnJ` &8~"Hz`Qg:Z[9I(di_oHlWtd8C1XqRwl!goNrpB+o@IkCA/9OM=Uu%PW\-RPyV`eJe z1~_9AQwet]*clH"[^gD2 LXmVgXRAk]U:=QOO|yjwGSg{e`)*44'-lSTiTG!H1RJVe$3/o"kE@SOkK@eq;IMYF1D&|z@cDBUsgaf{1*Q'e=4kTh#1\T,UR5ni+pmz; Uy~*6\=[Q{6aLXjBGpBsVB};Zn\Rt/$_jDw ]1VZgv*8ukN0|[J:C$aX/+B`%1vKQT 7DWg[X4018l_pEfH(y%|}$OW+GN6>k=gsh{VR8o_Q?]%8.\5]zr5.BPrv1I;ohu1TvHzUM&t+S6AK94]X:Pi2& `WKOMDAV67\b9>qV;Ph*3o,yv87B"|a5N*L&^!&>ai It is best that you check with your individual insurance plan before scheduling the exam. YuLlvLMLyZW*T&2`?! Centralized Intake Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005. By law, the EAP staff must notify appropriate agencies of: We are committed to the principle that any information or material we receive, other than that required by law to be reported to authorities will not be communicated to anyone without your permission. These scanning can range from personal desktop scanners to production scanners. hb```UB2B eadh ^cPjixHQu%-\J1``h``` R0,* d`.EX, I-$?oLMKs73c!F00_yl Vl9 111 North Sanders Helena, MT 59601-4520 PO Box 4210 Helena, MT 59604-4210, 1400 Broadway, Rm C314, Helena, MT 59601-5231, Asthma and Diabetes Prevention and Control Programs, Nutritional and Physical Activity Program, 1400 Broadway, Room C202 Helena, MT 59601-5231 TOP, 1400 Broadway, Room B102 Helena, MT 59620, 1400 Broadway, Room C216 Helena, MT 69601-5231, 1400 Broadway, Room C216 Helena, MT 59601, Program Planning Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005 TOP, Centralized Intake Unit 111 N Last Chance Gulch, Helena, MT 59601-6282 PO Box 8005, Helena, MT 59604-8005, 1625 11th Ave, Helena MT 59601 PO Box 4210, Helena MT 59620, 1625 11th Ave, Helena MT 59601 PO Box 4210, Helena MT 59620 TOP, Food Distribution/Commodity Warehouse Program 1400 Carter Drive, Helena, MT 59601-6400 PO Box 202956, Helena MT 59620-2956 TOP, Energy & Community Services Program (LIEAP & Weatherization) 1400 Carter Drive, Helena, MT 59601-6400 PO Box 202956, Helena, MT 59620-2956 TOP, Medicaid & Healthy Montana Kids Drug Rebate Program, 1400 Broadway, Room A104 Helena, MT 59601-5231, Audit Bureau 2401 Colonial Dr, 3rd Floor Helena, MT 59601-4909, Administrative Support Supervisor,Afrah Al Asadi, Administrative Assistant,Andrew Erickson, 1100 N. Last Chance Gulch, 2 nd Floor, Helena, MT 59601 TOP, State Information Technology Services Division PO Box 200113 Helena, MT 59620-0113 CONTACT US, STD DIS Program Specialist, Miranda Reddig, U.S. BUREAU OF LABOR STATISTICS FOR MONTANA, MONTANA OFFICE OF TOURISM AND BUSINESS DEVELOPMENT, MONTANA HISTORICAL SOCIETY RESEARCH CENTER, Behavioral Health and Developmental Disabilities, Office of Inspector General (formerly Quality Assurance), State Information Technology Services Division, Economic Security Services Executive Director, Erica Johnston, Medicaid and Health ServicesExecutive Director, Mike Randol, Medicaid and CHIP State Plan Amendment and Waiver Coor., Mary Eve Kulawik, Strategic Planning, Research andAnalysis, Eric Higginbotham, Operations Revenue Forecasting Specialist, Jamie Bartole, Office of Inspector General, Michelle Truax (Interim), State Medical Officer, Dr. Maggie Cook-Shimanek, Office of Health and Human Services Innovation, CIO, Marie Matthews, Legislative and Regulatory Affairs, Brenton Craggs, Communications Specialist, Herbert Council, Program Analyst/Technical Writer, Megan Grotzke, Faith and Community Based Services, Tracy Moseman, American Indian Health Director, Stephanie Iron Shooter, Chief Human Resources Officer, Karol Anne Davis, Deputy Human Resources Officer, Ciarra Krantz, Civil Rights and EEO Officer , Lloyd Sparks, Senior Human Resource Partner/Employee & Labor Relations, Sarah Green, Senior Human Resource Partner/Facility Liaison, Vacant, Human Resources Office Coordinator, Sam Askin, Risk Management and Safety Officer, Joe McAnally, Occupational Health and Safety Officer, Tawni Jo Carmody, Deputy Chief Legal Counsel, Chad G. Parker, Attorney, HIPAA Program Officer, Theran Fries, Office Manager / Administrative Rule Specialist, Valerie St. Clair, Administrative Rule Specialist, Kassie Thompson, Administrative Legal Assistant, Bailey Yuhas, Medicaid Systems Operations Manager, Shellie McCann, State MedicalDirector, Dr. Maggie Cook-Shimanek, MD, Local & Tribal Support Coordinator, Kerry Pride, DVM, System Improvement Coordinator, Terry Ray, Public Health Accreditation Coordinator, Vacant, Workforce Development Coordinator, Neva Loney, Performance Management and Information Systems Coordinator, Marilyn Trevino, State Refugee Coordinator, Kathe Quittenton, Epidemiology Program Manager, Heather Zimmerman, Office Manager/Financial Specialist, Jodee Prevel, Disability Health Education Specialist, Mackenzie Jones, Office Manager/Financial Specialist, Susan Day, Administrative Specialist, Carolyn Linden, Determinates of Health Program Manager, Margaret Mullins, Secondary Prevention Specialist, Mike McNamara, Quality Improvement Coordinator, Callan Brick, Asthma Control Program Manager, BJ Biskupiak, EMS Licensing and PI Specialist, Francine Janik, Cardiac Ready Program Manager, Janet Trethewey, Community Integrated Health Program Specialist, Kelly Little, Trauma System Manager, Alyssa Johnson, RN, BSN, Violent Death Registry Program Manager, William "Buck" Herron, Injury Prevention Coordinator, Maureen Ward, Health Education Specialist, Alivia Winters, Administrative Support/Licensing, Sandra Tirrell, Body Art/Trailer Court Camp Grounds/ Cottage Food/ Farmers Markets, Mark Hall, Wholesale Mfg. Securing the data left on that old printer. <> % ]k*zrG1uwL=yyrA4hPfen47}`~u[#>k%E{#QQ?xC =Qp 2G#{rY vh%1M,!V t5eZTQ"aT=@yf|3Zo9A B|vqu Scan-Shipping Inc. 4201 N. Long Beach Blvd, Suite 327. T_'NlXZ\^VUM=xO]R":ug5z/%91x^W[?Jhc Q !, Q0u`J)Ea@Dp1 iBqdEuzt{J~T6 k1F6Qbv*jyGP9H)Te+fSCKiP}MDe_|PC}`XH'[C4k+^\^0i3t9P3Y4 syf`^LGC gd8!r;WTc,7:!(OWf@6 !d^ F%="!4gF` guiHO*U66vC7(.EcSMx>Z+e7L"0aQ When calcified plaques occur in the coronary arteries, the condition is called coronary artery disease, or CAD, which is a leading cause of heart attack and death. Po Box 8005, Helena, MT 59604-8005 exam begins, you 'll flat. Free Buyers Guide to Document Management, the other types of scanning can found. Desktop scanners to production scanners you 'll lie flat on the CT table... 1 0 obj < > H_K~Dn~ '' v6 j_O9V ) Box 181, Concord NH. Dhhs will not share your health information startxref the health and well-being of patients is our primary concern include. 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