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Get NY RSA-7B 2012-2024

H Aid Services Billing Form: RSA - 7B Invoice No: Student / Independent / Agency Information Name of Student: OSIS / NYC ID # Name of Nurse / Health Aide: Social Security # Name of Agency: Employers Tax ID # Date of Service Time - In Total # of Sessions: Time - Out Rate: Hours Total Amount Total Amount Due: Certification This is to certify that the above information is true and accurate and all services have been provided. Signature of Nurse/Health Aide: Date: Signature of Prin.

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