Get Individuals Seeking An Exemption From The Following Requirements Shall Use This Form: - Med-quest

This guide provides a clear and concise overview of how to complete the Individuals Seeking An Exemption From The Following Requirements Shall Use This Form: - Med-quest. Follow these steps thoroughly to ensure your submission is accurate and complete.

Follow the steps to successfully complete your exemption request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete a separate DHS 1200 form for each exemption being requested. For instance, if you require exemptions from both a Criminal Conviction Record Check and a Protective Services Central Registry Check, ensure that you fill out and submit two distinct DHS 1200 forms.
3. In Section I, 'Individual Seeking Exemption', provide personal information, including your name and signature, social security number, date of birth, home and mailing addresses, and both home and business telephone numbers.
4. Proceed to Section II, 'Reasons for Exemption'. This section requires your responses to the specified questions. Ensure your answers are accurate and complete.
5. Once the form is fully completed, return it to the following address: Fieldprint, Inc., 12000 Commerce Parkway, Suite 100, Mount Laurel, NJ 08054.
6. It is important to retain copies of the completed form for your own records. Additionally, an original, completed form must be sent to the DHS designee at the aforementioned address.

Take the next step and complete your exemption request online today.