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OUR COMMUNITY HEALTH CENTER PAYMENT AGREEMENT PATIENT NAME: RESPONSIBLE PARTY NAME: PATIENT ACCOUNT NO: LAST DATE OF SERVICE: BALANCE DUE ON ACCOUNT: $ PAYMENT AMOUNT: $ WEEKLY / MONTHLY I hereby.

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Form 5C: Other Activities/Locations (PDF - 156 KB) lists health center activities that 1) do not meet the service site definition, 2) are conducted on an irregular timeframe or schedule, and 3) offer a limited activity from within the full complement of health center activities within the scope of project.

Tens of millions of Americans receive quality, affordable health care and other services through HRSA's 90-plus programs and more than 3,000 grantees. HRSA programs provide equitable health care to people who are geographically isolated and economically or medically vulnerable.

The Bureau of Primary Health Care (BPHC) funds nearly 1,400 health centers. They provide affordable, accessible, and high-quality primary health care to underserved communities at nearly 15,000 sites.

What is a Change in Scope (CIS) request? If you need to make a change to your scope of project, you must submit a CIS request through the Electronic Handbooks (EHBs). This allows HRSA to review and approve the change. There are two kinds of CIS requests: Formal - a formal CIS is for a significant change.

Substantive programmatic work The primary project activities for which grant support is provided.

HRSA (Health Resources and Services Administration).

The Form 5A service descriptors outline the general elements for all services, both Required and Additional, to assist in accurate recording of the approved Health Center Program scope of project.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232