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UNM Hospital Patient Care Fund - cirseiu 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Patient Name and Medical Record Number (MR#) in the designated fields. Ensure accuracy as this information is crucial for processing.
- Fill in the Patient Address and Date of Birth (DOB). This helps verify the patient's identity and eligibility for assistance.
- In the Medications section, list all required medications clearly. Be specific to avoid any confusion during processing.
- Have the prescribing doctor sign and print their name, along with their DEA number and NPI number. This validates the prescription request.
- Finally, ensure that a patient sticker is affixed to the form, as it will be void without it. Review all entries for completeness before submission.
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Related links
Aug 31, 2019 UNM shall contribute $45,000 each year on July 1 as a CIR-UNM Patient Care Fund against which the CIR-UNM Patient Care Fund Committee can makeRead more
Patient Care Trust Fund 10-27 46 Ave, Suite 300-2. Long Island City NY 11101 Question 11(a): PAC FUND (CIR-SEIU LOCAL 1957 HEALTH CARE ADVOCACY FUND)Read more