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Document Mentions (3 shared documents)
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Telephone Number State Zip 1. How is health care provided for this student? _employment Insurance _private insurance _social security insurance Medicaid Other 2. With whom does this student live? I t r HE' mHt F T[ pH , N 3. Does this student have any of the following health conditions: asthma
, or its legal representatives, any and all such information. I AGREE that a photographic copy of this Authorization will be valid as the original. Parent/Guardian: Insurance Carrier: Address: Address: City/State/Zip: City/State/Zip: Home #: Policy/Medicaid: Work #: Claim Service #:
2 mentions1 same-page
Page ?Same page
0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate K Interested in receiving information 7. All new students to Palm Beach County are required to answer the followin
oblem)? Any significant injury or accident (specify problem)? Would you like to discuss anything about your child's health with a school nurse? To Parent/Guardian: Please explain any "Yes" answers from above. I am the parent/guardian of the child named above. I give permission for the information on PARTS I an
2 mentions1 same-page
Page ?Same page
0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate K Interested in receiving information 7. All new students to Palm Beach County are required to answer the followin
oblem)? Any significant injury or accident (specify problem)? Would you like to discuss anything about your child's health with a school nurse? To Parent/Guardian: Please explain any "Yes" answers from above. I am the parent/guardian of the child named above. I give permission for the information on PARTS I an
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Mutual Connections (137)
Entities connected to both Medicaid and Parent/Guardian
Jeffrey Epstein
PERSON114 w/ Medicaid·2 w/ Parent/Guardian
LB
Leon Black
PERSON61 w/ Medicaid·2 w/ Parent/Guardian
DB
Doug Band
PERSON46 w/ Medicaid·2 w/ Parent/Guardian
Samantha Power
PERSON43 w/ Medicaid·2 w/ Parent/Guardian
Alfredo Rodriguez
PERSON26 w/ Medicaid·2 w/ Parent/Guardian
Vince Foster
PERSON18 w/ Medicaid·2 w/ Parent/Guardian
Tallahassee
LOCATION15 w/ Medicaid·2 w/ Parent/Guardian
Vicky Ward
PERSON14 w/ Medicaid·2 w/ Parent/Guardian
National Guard
ORGANIZATION12 w/ Medicaid·2 w/ Parent/Guardian
Tampa
LOCATION10 w/ Medicaid·2 w/ Parent/Guardian
Jacksonville
LOCATION8 w/ Medicaid·2 w/ Parent/Guardian
Air Force
ORGANIZATION7 w/ Medicaid·2 w/ Parent/Guardian
Legal Authority
ORGANIZATION6 w/ Medicaid·2 w/ Parent/Guardian
Coast Guard
ORGANIZATION6 w/ Medicaid·2 w/ Parent/Guardian
Mathematics Scale Scores
ORGANIZATION5 w/ Medicaid·2 w/ Parent/Guardian
UR
Urban
PERSON5 w/ Medicaid·2 w/ Parent/Guardian
Data Analysis
ORGANIZATION5 w/ Medicaid·2 w/ Parent/Guardian
MIAMI FL
LOCATION5 w/ Medicaid·2 w/ Parent/Guardian
Permanent Medical Exemption
ORGANIZATION5 w/ Medicaid·2 w/ Parent/Guardian
the Coast Guard
ORGANIZATION4 w/ Medicaid·2 w/ Parent/Guardian