{"id":226654,"date":"2021-06-03T13:34:58","date_gmt":"2021-06-03T20:34:58","guid":{"rendered":""},"modified":"2026-05-13T08:17:15","modified_gmt":"2026-05-13T15:17:15","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.carewellseiu503.org\/ar\/resources\/forms\/","title":{"rendered":"\u0627\u0633\u062a\u0645\u0627\u0631\u0627\u062a \u0627\u0644\u0633\u062f\u0627\u062f \u0648\u0627\u0644\u062a\u0633\u062c\u064a\u0644 (Enrollment and Reimbursement Forms)"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ffffff&#8221; background_enable_image=&#8221;off&#8221; background_position=&#8221;bottom_left&#8221; min_height=&#8221;350px&#8221; min_height_tablet=&#8221;100px&#8221; min_height_phone=&#8221;&#8221; min_height_last_edited=&#8221;on|phone&#8221; custom_margin=&#8221;||0px||false|false&#8221; 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custom_margin=&#8221;|0px||0px|false|true&#8221; custom_padding=&#8221;1px||2px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p dir=\"rtl\">\u0644\u0643\u064a \u062a\u0643\u0648\u0646 \u0645\u0624\u0647\u0651\u064e\u0644\u0627\u064b \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u0645\u0632\u0627\u064a\u0627 Carewell\u060c \u064a\u062c\u0628 \u0639\u0644\u0649 \u0645\u0624\u0633\u0633\u0629 Carewell SEIU 503 \u0623\u0646 \u062a\u062d\u062a\u0641\u0638 \u0628\u0627\u0633\u0645\u0643\u060c \u0648\u0646\u0648\u0639\u0643\u060c \u0648\u0631\u0642\u0645 \u0627\u0644\u0636\u0645\u0627\u0646 \u0627\u0644\u0627\u062c\u062a\u0645\u0627\u0639\u064a \u0627\u0644\u062e\u0627\u0635 \u0628\u0643\u060c \u0648\u062a\u0627\u0631\u064a\u062e \u0645\u064a\u0644\u0627\u062f\u0643\u060c \u0648\u0639\u0646\u0648\u0627\u0646\u0643 \u0627\u0644\u062d\u0627\u0644\u064a \u0641\u064a \u0627\u0644\u0645\u0644\u0641. \u064a\u0646\u0628\u063a\u064a \u0627\u0644\u062a\u0623\u0643\u062f \u0623\u064a\u0636\u064b\u0627 \u0645\u0646 \u062d\u0635\u0648\u0644 \u0627\u0644\u0648\u0644\u0627\u064a\u0629 \u0639\u0644\u0649 \u0623\u062d\u062f\u062b \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a. \u0645\u0644\u0627\u062d\u0638\u0629: \u064a\u0624\u062f\u064a \u062a\u0642\u062f\u064a\u0645 \u0647\u0630\u0647 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0625\u0644\u0649 \u0642\u064a\u0627\u0645 Carewell SEIU 503 \u0628\u062a\u0633\u062c\u064a\u0644\u0643 \u0641\u064a \u0645\u0632\u0627\u064a\u0627 \u0645\u0624\u0633\u0633\u0629 Carewell SEIU 503 \u0644\u0637\u0628 \u0627\u0644\u0623\u0633\u0646\u0627\u0646\u060c \u0648\u0627\u0644\u0633\u0645\u0639 \u0648\u0627\u0644\u0628\u0635\u0631\u060c \u0648\u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0645\u0648\u0638\u0641 \u0625\u0630\u0627 \u0643\u0646\u062a \u0645\u0624\u0647\u0651\u064e\u0644\u0627\u064b \u0644\u0647\u0630\u0647 \u0627\u0644\u0645\u0632\u0627\u064a\u0627.<\/p>\n<p dir=\"rtl\">&nbsp;<\/p>\n<ol dir=\"rtl\">\n<li><strong>\u0623\u0631\u0633\u0644 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0648\u0627\u0631\u062f\u0629 \u0623\u0639\u0644\u0627\u0647<\/strong> \u0644\u062a\u062d\u062f\u064a\u062b \u0645\u0639\u0644\u0648\u0645\u0627\u062a\u0643 \u0627\u0644\u0645\u0648\u062c\u0648\u062f\u0629 \u0644\u062f\u0649 \u0645\u0624\u0633\u0633\u0629 Carewell SEIU 503.<\/li>\n<li><strong>\u0627\u062a\u0628\u0639 \u0627\u0644\u0625\u0631\u0634\u0627\u062f\u0627\u062a \u0627\u0644\u0648\u0627\u0631\u062f\u0629 \u0623\u062f\u0646\u0627\u0647<\/strong> \u0644\u062a\u062d\u062f\u064a\u062b \u0645\u0639\u0644\u0648\u0645\u0627\u062a\u0643 \u0627\u0644\u0634\u062e\u0635\u064a\u0629 \u0627\u0644\u0645\u0648\u062c\u0648\u062f\u0629 \u0644\u062f\u0649 \u0627\u0644\u0648\u0644\u0627\u064a\u0629\u060c \u062d\u0633\u0628 \u0627\u0644\u0641\u0626\u0629 \u0627\u0644\u0648\u0638\u064a\u0641\u064a\u0629 \u0627\u0644\u062a\u064a \u062a\u0646\u062a\u0645\u064a \u0625\u0644\u064a\u0647\u0627.<\/li>\n<\/ol>\n<p>[\/et_pb_text][et_pb_code disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#582C82&#8243; text_orientation=&#8221;left&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"274291\"][\/et_pb_section][\/et_pb_code][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner column_structure=&#8221;1_3,1_3,1_3&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; make_equal=&#8221;on&#8221; module_class=&#8221;noAnimation&#8221; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;|0px||0px|false|true&#8221; custom_padding=&#8221;1px||3px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p dir=\"rtl\"><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\" dir=\"rtl\">\u0639\u0627\u0645\u0644 \u0631\u0639\u0627\u064a\u0629 \u0645\u0646\u0632\u0644\u064a\u0629 (HCW)<\/span><\/p>\n<p dir=\"rtl\">\u062d\u062f\u0651\u062b \u0639\u0646\u0648\u0627\u0646\u0643 \u0627\u0644\u0645\u0648\u062c\u0648\u062f \u0644\u062f\u0649 \u0627\u0644\u0645\u0643\u062a\u0628 \u0627\u0644\u0645\u062d\u0644\u064a \u0644\u0644\u0645\u0633\u0646\u064a\u0646 \u0648\u0627\u0644\u0623\u0634\u062e\u0627\u0635 \u0630\u0648\u064a \u0627\u0644\u0625\u0639\u0627\u0642\u0627\u062a (APD)\/\u0627\u0644\u0645\u0643\u062a\u0628 \u0627\u0644\u0625\u0642\u0644\u064a\u0645\u064a \u0644\u0648\u0643\u0627\u0644\u0629 \u0627\u0644\u0645\u0633\u0646\u064a\u0646 \u0627\u0644\u0645\u062d\u0644\u064a\u0629 (AAA). \u0645\u0646\u0633\u0642\/\u0645\u0648\u0638\u0641 \u0634\u0626\u0648\u0646 \u0627\u0644\u0639\u0627\u0645\u0644\u064a\u0646 \u0641\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0645\u0646\u0632\u0644\u064a\u0629 \u0627\u0644\u0645\u062d\u0644\u064a \u0647\u0648 \u0627\u0644\u0634\u062e\u0635 \u0627\u0644\u0645\u0646\u0627\u0633\u0628 \u0644\u0644\u062a\u0648\u0627\u0635\u0644 \u0645\u0639\u0647.<\/p>\n<ul dir=\"rtl\"><\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p dir=\"rtl\"><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\" dir=\"rtl\">\u0639\u0627\u0645\u0644 \u062f\u0639\u0645 \u0634\u062e\u0635\u064a (PSW) \u0641\u064a \u0645\u0643\u062a\u0628 \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0625\u0639\u0627\u0642\u0627\u062a \u0627\u0644\u0646\u0645\u0627\u0626\u064a\u0629 (ODDS)<\/span><\/p>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u062a\u0639\u062f\u064a\u0644 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a <a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/PSW-change-of-information-form.pdf\" target=\"_blank\" rel=\"noopener\">Change of Information form (PDF)<\/a> \u0644\u0644\u062a\u0623\u0643\u062f \u0645\u0646 \u0627\u0645\u062a\u0644\u0627\u0643 \u0648\u0632\u0627\u0631\u0629 \u0627\u0644\u0635\u062d\u0629 \u0648\u0627\u0644\u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0625\u0646\u0633\u0627\u0646\u064a\u0629 (DHS) \u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a\u0643 \u0627\u0644\u0645\u062d\u062f\u062b\u0629.<\/p>\n<ul dir=\"rtl\"><\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][et_pb_column_inner type=&#8221;1_3&#8243; saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p dir=\"rtl\"><span style=\"color: var(--main-color); font-family: univia-pro, 'Exo 2', sans-serif; font-size: 18px; font-weight: bold; letter-spacing: 0.7px;\" dir=\"rtl\">\u0639\u0627\u0645\u0644 \u062f\u0639\u0645 \u0634\u062e\u0635\u064a (PSW) \u0641\u064a \u0627\u0644\u0647\u064a\u0626\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0641\u064a \u0648\u0644\u0627\u064a\u0629 \u0623\u0648\u0631\u064a\u063a\u0648\u0646<\/span><\/p>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u062a\u062d\u062f\u064a\u062b \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u0632\u0648\u062f <a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/he3035.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Provider Information Update Form (PDF)<\/a> \u0644\u0644\u062a\u0623\u0643\u062f \u0645\u0646 \u0627\u0645\u062a\u0644\u0627\u0643 \u0627\u0644\u0647\u064a\u0626\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0641\u064a \u0648\u0644\u0627\u064a\u0629 \u0623\u0648\u0631\u064a\u063a\u0648\u0646 (OHA) \u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a\u0643 \u0627\u0644\u0645\u062d\u062f\u062b\u0629. \u0627\u0645\u0644\u0623 \u062c\u0645\u064a\u0639 \u0623\u0642\u0633\u0627\u0645 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0628\u0627\u0633\u062a\u062b\u0646\u0627\u0621 \u0627\u0644\u0622\u062a\u064a:<\/p>\n<ul dir=\"rtl\">\n<li>&#8220;\u0647\u0630\u0627 \u0627\u0644\u0642\u0633\u0645 \u062e\u0627\u0635 \u0628\u0627\u0644\u0645\u0624\u0633\u0633\u0627\u062a\u060c \u0648\u0627\u0644\u0645\u062c\u0645\u0648\u0639\u0627\u062a \u0648\u0627\u0644\u0648\u0643\u0627\u0644\u0627\u062a&#8221;<\/li>\n<li>&#8220;\u062a\u063a\u064a\u064a\u0631\u0627\u062a \u0643\u0648\u062f \u0627\u0644\u062a\u0635\u0646\u064a\u0641&#8221;<\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;dentalanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;dentalanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u062e\u062f\u0645\u0627\u062a \u0637\u0628 \u0627\u0644\u0623\u0633\u0646\u0627\u0646<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u062a\u0646\u0627\u0632\u0644 \u0639\u0646 \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (Benefits Waiver Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0625\u0642\u0631\u0627\u0631 \u0628\u0623\u0646\u0643 \u0639\u064f\u0631\u0636\u062a \u0639\u0644\u064a\u0643 \u062a\u063a\u0637\u064a\u0629 \u0628\u0631\u0646\u0627\u0645\u062c Carewell SEIU 503 \u0644\u0637\u0628 \u0627\u0644\u0623\u0633\u0646\u0627\u0646 \u0648\u0627\u0644\u0633\u0645\u0639 \u0648\u0627\u0644\u0628\u0635\u0631 \u0648\u0628\u0631\u0646\u0627\u0645\u062c \u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0645\u0648\u0638\u0641 (EAP) <u>\u0648\u0623\u0646\u0643 \u062a\u0631\u0641\u0636 \u0647\u0630\u0647 \u0627\u0644\u062a\u063a\u0637\u064a\u0629<\/u>.<br \/>[et_pb_section global_module=\"274298\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;visionanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;visionhearinganchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u0627\u0644\u0628\u0635\u0631 + \u0627\u0644\u0633\u0645\u0639<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0646\u0641\u0642\u0627\u062a \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0628\u0635\u0631 \u0645\u0646 Ameritas (\u0627\u0644\u0644\u064a\u0632\u0643 \u0641\u0642\u0637)<\/h5>\n<p dir=\"rtl\"><a href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/Lasik-claims-form.pdf\" class=\"noUnderline\" target=\"_blank\" rel=\"noopener\" dir=\"rtl\"> <i class=\"fas fa-file-pdf\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 PDF<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0646\u0641\u0642\u0627\u062a \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0633\u0645\u0639 \u0645\u0646 Ameritas<\/h5>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/www.carewellseiu503.org\/wp-content\/uploads\/soundcare-claims-form.pdf\" target=\"_blank\" rel=\"noopener\" dir=\"rtl\"> <i class=\"fas fa-file-pdf\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 PDF<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||25px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u062a\u0646\u0627\u0632\u0644 \u0639\u0646 \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (Benefits Waiver Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0625\u0642\u0631\u0627\u0631 \u0628\u0623\u0646\u0643 \u0639\u064f\u0631\u0636\u062a \u0639\u0644\u064a\u0643 \u062a\u063a\u0637\u064a\u0629 \u0628\u0631\u0646\u0627\u0645\u062c Carewell SEIU 503 \u0644\u0637\u0628 \u0627\u0644\u0623\u0633\u0646\u0627\u0646 \u0648\u0627\u0644\u0633\u0645\u0639 \u0648\u0627\u0644\u0628\u0635\u0631 \u0648\u0628\u0631\u0646\u0627\u0645\u062c \u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0645\u0648\u0638\u0641 (EAP) <u>\u0648\u0623\u0646\u0643 \u062a\u0631\u0641\u0636 \u0647\u0630\u0647 \u0627\u0644\u062a\u063a\u0637\u064a\u0629<\/u>.<br \/>[et_pb_section global_module=\"274298\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.21.0&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u0633\u062f\u0627\u062f \u0644\u0623\u0639\u0636\u0627\u0621 VSP\u200f (VSP Member Reimbursement Form)<\/h5>\n<p dir=\"rtl\"><span style=\"font-weight: 400;\" dir=\"rtl\">\u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a\u064b\u0627 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0628\u0648\u0627\u0628\u0629 VSP \u0639\u0644\u0649 <a href=\"https:\/\/www.vsp.com\/\">vsp.com.<\/a> \u064a\u062a\u0639\u064a\u0651\u0646 \u0639\u0644\u064a\u0643 \u0625\u0646\u0634\u0627\u0621 \u062d\u0633\u0627\u0628 \u0623\u0648\u0644\u0627\u064b. \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0644\u062f\u064a\u0643 \u0623\u0633\u0626\u0644\u0629\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0628\u0648\u0643\u0627\u0644\u0629 VSP \u0639\u0644\u0649 \u0627\u0644\u0631\u0642\u0645 \u200e1-800-877-7195.<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;eapanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;eapanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u0628\u0631\u0646\u0627\u0645\u062c \u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0645\u0648\u0638\u0641<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u062a\u0646\u0627\u0632\u0644 \u0639\u0646 \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (Benefits Waiver Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0625\u0642\u0631\u0627\u0631 \u0628\u0623\u0646\u0643 \u0639\u064f\u0631\u0636\u062a \u0639\u0644\u064a\u0643 \u062a\u063a\u0637\u064a\u0629 \u0628\u0631\u0646\u0627\u0645\u062c Carewell SEIU 503 \u0644\u0637\u0628 \u0627\u0644\u0623\u0633\u0646\u0627\u0646 \u0648\u0627\u0644\u0633\u0645\u0639 \u0648\u0627\u0644\u0628\u0635\u0631 \u0648\u0628\u0631\u0646\u0627\u0645\u062c \u0645\u0633\u0627\u0639\u062f\u0629 \u0627\u0644\u0645\u0648\u0638\u0641 (EAP) <u>\u0648\u0623\u0646\u0643 \u062a\u0631\u0641\u0636 \u0647\u0630\u0647 \u0627\u0644\u062a\u063a\u0637\u064a\u0629<\/u>.<br \/>\n[et_pb_section global_module=\"274298\"][\/et_pb_section][\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner module_id=&#8221;hcaanchor&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;hcaapanchor&#8221; _builder_version=&#8221;4.27.6&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629<\/h2>\n<h3 dir=\"rtl\">\u0644\u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646<\/h3>\n<h5 dir=\"rtl\">\u0627\u0644\u062e\u0637\u0637 \u0627\u0644\u0645\u0639\u062a\u0645\u062f\u0629 \u0645\u0646 Carewell<\/h5>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0644\u0623\u0648\u0631\u0627\u0642 \u0627\u0644\u0633\u0646\u0648\u064a\u0629 \u0644\u0639\u0627\u0645 2026<\/h5>\n<p dir=\"rtl\">\u064a\u0624\u0643\u062f \u0625\u0643\u0645\u0627\u0644\u0643 \u0644\u0644\u0623\u0648\u0631\u0627\u0642 \u0627\u0644\u0633\u0646\u0648\u064a\u0629 \u0641\u0647\u0645\u0643 \u0648\u0645\u0648\u0627\u0641\u0642\u062a\u0643 \u0639\u0644\u0649 \u0642\u0648\u0627\u0639\u062f \u0627\u0644\u0628\u0631\u0646\u0627\u0645\u062c \u0648\u0641\u0642\u064b\u0627 \u0644\u0642\u0648\u0627\u0639\u062f \u0627\u0644\u0635\u0646\u062f\u0648\u0642 \u0627\u0644\u0627\u0626\u062a\u0645\u0627\u0646\u064a. \u0643\u0645\u0627 \u062a\u0639\u0637\u064a \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0627\u062a \u0644\u0641\u0631\u064a\u0642 Carewell SEIU 503 \u0644\u0644\u0645\u0632\u0627\u064a\u0627 (Carewell SEIU 503 Benefits) \u0627\u0644\u0625\u0630\u0646 \u0628\u0645\u0633\u0627\u0639\u062f\u062a\u0643 \u0641\u064a \u0627\u0644\u062a\u0633\u062c\u064a\u0644 \u0648\u0627\u0644\u062d\u0641\u0627\u0638 \u0639\u0644\u0649 \u062a\u063a\u0637\u064a\u0629 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0643. <strong dir=\"rtl\">\u0644\u0627 \u062a\u0645\u062b\u0651\u0650\u0644 \u0647\u0630\u0647 \u0627\u0644\u0623\u0648\u0631\u0627\u0642 \u0637\u0644\u0628\u064b\u0627 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0623\u0645\u064a\u0646 \u0635\u062d\u064a.<\/strong><\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/252867451707869?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i>\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 dir=\"rtl\"><strong dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0637\u0644\u0628 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 (Healthcare Cost Assistance Benefits Request Form) \u0644\u062e\u0637\u0637 \u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646<\/strong><\/h5>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0637\u0644\u0628 \u0627\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0644\u062e\u0637\u0637 \u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646. \u064a\u062c\u0628 \u0639\u0644\u064a\u0643 \u062a\u0636\u0645\u064a\u0646 \u0625\u062e\u0637\u0627\u0631 \u0623\u0647\u0644\u064a\u0629 \u062e\u0637\u0637 \u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u062e\u0627\u0635 \u0628\u0643 \u0648\u0641\u0627\u062a\u0648\u0631\u0629 \u0627\u0644\u0642\u0633\u0637 <span>\u0623\u0648 \u0635\u0641\u062d\u0629 &#8220;\u062e\u0637\u0637\u064a \u0648\u0628\u0631\u0627\u0645\u062c\u064a&#8221; \u0645\u0646 \u062d\u0633\u0627\u0628 <a href=\"https:\/\/www.healthcare.gov\/\">HealthCare.gov<\/a> \u0627\u0644\u062e\u0627\u0635 \u0628\u0643<\/span> \u0644\u062a\u0643\u0648\u0646 \u0645\u0624\u0647\u0651\u064e\u0644\u064b\u0627 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0644\u0643 \u0627\u0644\u0645\u064a\u0632\u0629. \u0648\u0625\u0630\u0627 \u0643\u0646\u062a \u0645\u0633\u062c\u0644\u0627\u064b \u0641\u064a \u062e\u0637\u0629 \u0645\u0639\u062a\u0645\u062f\u0629 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0648\u0643\u0627\u0644\u0629 Valley Insurance Professionals\u060c \u0641\u0644\u0646 \u062a\u062d\u062a\u0627\u062c \u0625\u0644\u0649 \u0625\u0631\u0633\u0627\u0644 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/232535085492156?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0644\u062a\u0641\u0648\u064a\u0636 \u0628\u0645\u0648\u062c\u0628 \u0642\u0627\u0646\u0648\u0646 \u0625\u062e\u0636\u0627\u0639 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0635\u062d\u064a \u0644\u0642\u0627\u0628\u0644\u064a\u0629 \u0627\u0644\u0646\u0642\u0644 \u0648\u0627\u0644\u0645\u0633\u0627\u0621\u0644\u0629 (HIPPA)<\/h5>\n<p dir=\"rtl\">\u064a\u062e\u0628\u0631\u0643 \u0647\u0630\u0627 \u0627\u0644\u0625\u062e\u0637\u0627\u0631 \u0639\u0646 \u0627\u0644\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u062a\u064a \u0642\u062f \u062a\u0633\u062a\u062e\u062f\u0645 \u0628\u0647\u0627 \u0645\u0624\u0633\u0633\u0629 Carewell SEIU 503 \u0645\u0639\u0644\u0648\u0645\u0627\u062a\u0643 \u0627\u0644\u0635\u062d\u064a\u0629 \u0648\u062a\u0634\u0627\u0631\u0643\u0647\u0627. \u0648\u064a\u0634\u0645\u0644 \u0623\u064a\u0636\u064b\u0627 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0628\u0634\u0623\u0646 \u062d\u0642\u0648\u0642\u0643 \u0641\u064a \u0627\u0644\u062e\u0635\u0648\u0635\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/231864587972170?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0628\u064a\u0627\u0646 \u0627\u0644\u062a\u0641\u0627\u0647\u0645<\/h5>\n<p dir=\"rtl\">\u0647\u0630\u0627 \u0627\u0644\u0625\u062e\u0637\u0627\u0631 \u0645\u0648\u062c\u0647 \u0644\u0645\u0642\u062f\u0645\u064a \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0645\u0646 \u0623\u062c\u0644 \u0627\u0644\u0625\u0642\u0631\u0627\u0631 \u0628\u0645\u0633\u0624\u0648\u0644\u064a\u0627\u062a\u0647\u0645 \u0641\u064a \u062a\u0644\u0642\u064a \u0645\u0632\u0627\u064a\u0627 Carewell SEIU 503.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/231864571238158?language=ar\" target=\"_blank\" rel=\"noopener\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 dir=\"rtl\" style=\"text-align: right;\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0642\u0628\u0648\u0644 \u0628\u0627\u0644\u0625\u0641\u0631\u0627\u062c \u0639\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a (Consent to Release Information Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0631\u063a\u0628\u062a \u0641\u064a \u0627\u0644\u0633\u0645\u0627\u062d \u0644\u0623\u062d\u062f \u0645\u0646 \u0623\u0641\u0631\u0627\u062f \u0627\u0644\u0623\u0633\u0631\u0629 \u0623\u0648 \u0627\u0644\u0623\u0635\u062f\u0642\u0627\u0621 \u0628\u0637\u0631\u062d \u0627\u0644\u0627\u0633\u062a\u0641\u0633\u0627\u0631\u0627\u062a \u0648\u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0645\u0648\u0627\u0639\u064a\u062f \u0648\u062a\u0623\u0643\u064a\u062f \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0646\u064a\u0627\u0628\u0629 \u0639\u0646\u0643.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" dir=\"rtl\" href=\"https:\/\/risepartnership.jotform.com\/241904503930148?language=ar\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0643\u064a\u0644 \u0627\u0644\u062a\u0633\u062c\u064a\u0644 \u0644\u0648\u0643\u0627\u0644\u0629 Valley Insurance Professionals (VIP)<\/h5>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u062a\u0639\u064a\u064a\u0646 \u0648\u0643\u0627\u0644\u0629 VIP \u0643\u0648\u0643\u064a\u0644 \u0648\u0633\u064a\u0637 \u0644\u062a\u0645\u062b\u064a\u0644\u0643 \u0648\u0645\u0633\u0627\u0639\u062f\u062a\u0643 \u0641\u064a \u0625\u062f\u0627\u0631\u0629 \u0628\u0648\u0644\u064a\u0635\u0629 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0643.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/232825752182155?language=ar\" target=\"_blank\" rel=\"noopener\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#FFFFFF&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631 (Direct Deposit Form)<\/h5>\n<p dir=\"rtl\">\u0633\u062c\u0651\u0644 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0623\u0642\u0633\u0627\u0637\u0643 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631. \u0647\u0630\u0647 \u0647\u064a \u0627\u0644\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0623\u0633\u0631\u0639 \u0648\u0627\u0644\u0623\u0643\u062b\u0631 \u0623\u0645\u0627\u0646\u064b\u0627 \u0644\u062a\u0644\u0642\u064a \u062f\u0641\u0639\u062a\u0643. <strong>\u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u062f\u0631\u062c \u0646\u0633\u062e\u0629 \u0645\u0646 \u0634\u064a\u0643 \u0645\u064f\u0644\u063a\u0649\u060c \u0623\u0648 \u062e\u0637\u0627\u0628 \u0628\u0646\u0643\u064a \u0623\u0648 \u0628\u064a\u0627\u0646 \u062d\u0633\u0627\u0628\u0643 \u0627\u0644\u0628\u0646\u0643\u064a.<\/strong><br \/>[et_pb_section global_module=\"274302\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0623\u0642\u0633\u0627\u0637 \u0627\u0644\u0646\u0641\u0642\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629 (Medical Premium Reimbursement Claim Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u062a\u0639\u0648\u064a\u0636 \u0639\u0646 \u0627\u0644\u0623\u0642\u0633\u0627\u0637 \u0625\u0630\u0627 \u0643\u0646\u062a \u0645\u0633\u062c\u0644\u0627\u064b \u0645\u0639 \u0623\u0641\u0631\u0627\u062f \u0627\u0644\u0623\u0633\u0631\u0629 \u0641\u064a \u062e\u0637\u062a\u0643 \u0627\u0644\u062a\u0623\u0645\u064a\u0646\u064a\u0629 \u0623\u0648 \u0643\u0646\u062a \u0645\u0624\u0647\u0651\u064e\u0644\u0627\u064b \u0644\u062a\u0644\u0642\u064a \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0645\u062a\u0648\u0633\u0637 \u0642\u0633\u0637 \u0627\u0644\u0633\u062f\u0627\u062f\u200b\u0627\u0644\u0645\u0624\u0642\u062a\u0629 (APR) \u0639\u0646 \u062e\u0637\u0629 \u063a\u064a\u0631 \u0645\u0639\u062a\u0645\u062f\u0629. \u0644\u0627 \u0628\u062f \u0645\u0646 \u062a\u0642\u062f\u064a\u0645 \u0630\u0644\u0643 \u0645\u0639 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062a\u063a\u0637\u064a\u0629 \u0627\u0644\u062a\u0623\u0645\u064a\u0646\u064a\u0629 \u0627\u0644\u0641\u0631\u062f\u064a\u0629.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/240956049702964?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> \u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0623\u0642\u0633\u0627\u0637 \u0627\u0644\u0646\u0641\u0642\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629 (Medical Premium Reimbursement Claim Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u062a\u0639\u0648\u064a\u0636 \u0639\u0646 \u0627\u0644\u0623\u0642\u0633\u0627\u0637 \u0625\u0630\u0627 \u0643\u0646\u062a \u0645\u0633\u062c\u0644\u0627\u064b \u0645\u0639 \u0623\u0641\u0631\u0627\u062f \u0627\u0644\u0623\u0633\u0631\u0629 \u0641\u064a \u062e\u0637\u062a\u0643 \u0627\u0644\u062a\u0623\u0645\u064a\u0646\u064a\u0629 \u0623\u0648 \u0643\u0646\u062a \u0645\u0624\u0647\u0651\u064e\u0644\u0627\u064b \u0644\u062a\u0644\u0642\u064a \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0645\u062a\u0648\u0633\u0637 \u0642\u0633\u0637 \u0627\u0644\u0633\u062f\u0627\u062f\u200b\u0627\u0644\u0645\u0624\u0642\u062a\u0629 (APR) \u0639\u0646 \u062e\u0637\u0629 \u063a\u064a\u0631 \u0645\u0639\u062a\u0645\u062f\u0629. \u0644\u0627 \u0628\u062f \u0645\u0646 \u062a\u0642\u062f\u064a\u0645 \u0630\u0644\u0643 \u0645\u0639 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062a\u063a\u0637\u064a\u0629 \u0627\u0644\u062a\u0623\u0645\u064a\u0646\u064a\u0629 \u0627\u0644\u0641\u0631\u062f\u064a\u0629.<br \/>\n[et_pb_section global_module=\"274303\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; disabled_on=&#8221;off|off|off&#8221; module_class=&#8221;twoColumns&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||25px||false|true&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|true&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;0px|0px|0px|0px|false|true&#8221; border_radii=&#8221;on|0px|0px|0px|0px&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u0633\u062f\u0627\u062f \u0645\u0646 Ameriflex\u200f (Ameriflex Reimbursement Claim Form)<\/h5>\n<p class=\"p1\" dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u0633\u062f\u0627\u062f \u0639\u0646\u062f\u0645\u0627 \u062a\u062f\u0641\u0639 \u0645\u0642\u0627\u0628\u0644 \u0646\u0641\u0642\u0627\u062a \u0645\u063a\u0637\u0627\u0629 \u0645\u0646 \u0623\u0645\u0648\u0627\u0644\u0643 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u062f\u0644\u0627\u064b \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0628\u0637\u0627\u0642\u0629 \u062a\u0633\u0647\u064a\u0644\u0627\u062a \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (BCC). \u064a\u0645\u0643\u0646\u0643 \u0623\u064a\u0636\u064b\u0627 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0643\u0646\u062a \u0628\u062d\u0627\u062c\u0629 \u0625\u0644\u0649 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0642\u0633\u0637\u0643 \u0627\u0644\u0634\u0647\u0631\u064a \u0627\u0644\u0635\u0627\u0641\u064a \u0644\u062e\u0637\u0629 \u0641\u0631\u062f\u064a\u0629 \u0645\u0639\u062a\u0645\u062f\u0629 \u0645\u0646 Carewell \u062a\u0645 \u0634\u0631\u0627\u0624\u0647\u0627 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0635\u062d\u064a.\u00a0<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/participant.myameriflex.com\/#\/login?returnUrl=https%253A%252F%252Fparticipant.myameriflex.com%252F\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_code _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"294390\"][\/et_pb_section][\/et_pb_code][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u062a\u0639\u062f\u064a\u0644 \u0627\u0644\u0642\u0633\u0637 \u0627\u0644\u0645\u062a\u0642\u062f\u0645 \u0644\u0644\u0627\u0626\u062a\u0645\u0627\u0646 \u0627\u0644\u0636\u0631\u064a\u0628\u064a (Advance Premium Tax Credit Adjustment Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0643\u0627\u0646 \u062f\u062e\u0644\u0643 \u0645\u062e\u062a\u0644\u0641\u064b\u0627 \u0639\u0646 \u0627\u0644\u062f\u062e\u0644 \u0627\u0644\u0630\u064a \u0623\u0628\u0644\u063a\u062a\u0647 \u0625\u0644\u0649 \u062f\u0627\u0626\u0631\u0629 \u0627\u0644\u0625\u064a\u0631\u0627\u062f\u0627\u062a \u0627\u0644\u062f\u0627\u062e\u0644\u064a\u0629 (IRS) \u0641\u064a \u0637\u0644\u0628 \u0627\u0644\u0633\u0648\u0642. \u0633\u062a\u064f\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0645\u0633\u0627\u0639\u062f\u062a\u0646\u0627 \u0641\u064a \u062a\u062d\u062f\u064a\u062f \u0645\u0627 \u0625\u0630\u0627 \u0643\u0627\u0646 \u0628\u0625\u0645\u0643\u0627\u0646\u0646\u0627 \u0645\u0633\u0627\u0639\u062f\u062a\u0643 \u0641\u064a \u0633\u062f\u0627\u062f \u0627\u0644\u0645\u0628\u0644\u063a \u0627\u0644\u0630\u064a \u0644\u0645 \u062a\u062f\u0641\u0639\u0647 \u0628\u0639\u062f \u0623\u0648 \u0625\u0630\u0627 \u062a\u0644\u0642\u064a\u062a \u062f\u0641\u0639\u0629 \u0627\u0626\u062a\u0645\u0627\u0646\u064a\u0629 \u0636\u0631\u064a\u0628\u064a\u0629 \u0632\u0627\u0626\u062f\u0629. \u064a\u062c\u0628 \u062a\u0642\u062f\u064a\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0645\u0639 \u0627\u0644\u0648\u062b\u0627\u0626\u0642 \u0627\u0644\u0636\u0631\u064a\u0628\u064a\u0629 \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/231384757602156?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> \u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u062a\u0639\u062f\u064a\u0644 \u0627\u0644\u0642\u0633\u0637 \u0627\u0644\u0645\u062a\u0642\u062f\u0645 \u0644\u0644\u0627\u0626\u062a\u0645\u0627\u0646 \u0627\u0644\u0636\u0631\u064a\u0628\u064a (Advance Premium Tax Credit Adjustment Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0643\u0627\u0646 \u062f\u062e\u0644\u0643 \u0645\u062e\u062a\u0644\u0641\u064b\u0627 \u0639\u0646 \u0627\u0644\u062f\u062e\u0644 \u0627\u0644\u0630\u064a \u0623\u0628\u0644\u063a\u062a\u0647 \u0625\u0644\u0649 \u062f\u0627\u0626\u0631\u0629 \u0627\u0644\u0625\u064a\u0631\u0627\u062f\u0627\u062a \u0627\u0644\u062f\u0627\u062e\u0644\u064a\u0629 (IRS) \u0641\u064a \u0637\u0644\u0628 \u0627\u0644\u0633\u0648\u0642. \u0633\u062a\u064f\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0645\u0633\u0627\u0639\u062f\u062a\u0646\u0627 \u0641\u064a \u062a\u062d\u062f\u064a\u062f \u0645\u0627 \u0625\u0630\u0627 \u0643\u0627\u0646 \u0628\u0625\u0645\u0643\u0627\u0646\u0646\u0627 \u0645\u0633\u0627\u0639\u062f\u062a\u0643 \u0641\u064a \u0633\u062f\u0627\u062f \u0627\u0644\u0645\u0628\u0644\u063a \u0627\u0644\u0630\u064a \u0644\u0645 \u062a\u062f\u0641\u0639\u0647 \u0628\u0639\u062f \u0623\u0648 \u0625\u0630\u0627 \u062a\u0644\u0642\u064a\u062a \u062f\u0641\u0639\u0629 \u0627\u0626\u062a\u0645\u0627\u0646\u064a\u0629 \u0636\u0631\u064a\u0628\u064a\u0629 \u0632\u0627\u0626\u062f\u0629. \u064a\u062c\u0628 \u062a\u0642\u062f\u064a\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0645\u0639 \u0627\u0644\u0648\u062b\u0627\u0626\u0642 \u0627\u0644\u0636\u0631\u064a\u0628\u064a\u0629 \u0630\u0627\u062a \u0627\u0644\u0635\u0644\u0629.<br \/>\n[et_pb_section global_module=\"274304\"][\/et_pb_section][\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\"><span style=\"color: #582c82;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 (Overpayment Notice Appeal Form)<\/span><\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 \u0645\u0646 Carewell SEIU 503.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241416905043955?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px||2px|||&#8221; locked=&#8221;off&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;hcamedicareanchor&#8221; _builder_version=&#8221;4.16&#8243; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h2 dir=\"rtl\">\u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629<\/h2>\n<h3 dir=\"rtl\">\u0644\u062e\u0637\u0637 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare)<\/h3>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0637\u0644\u0628 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare)\u200f (Medicare Healthcare Cost Assistance Benefits Request Form)<\/h5>\n<p data-pm-slice=\"1 1 []\" dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u062a\u0642\u062f\u064a\u0645 \u0627\u0644\u0645\u0633\u062a\u0646\u062f\u0627\u062a \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629 \u0644\u0637\u0644\u0628 \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0639\u0646 \u062c\u0632\u0621 \u0645\u0646 \u0623\u0642\u0633\u0627\u0637 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare)\u060c \u0648\u0627\u0633\u062a\u0644\u0627\u0645 \u0623\u0645\u0648\u0627\u0644 \u0644\u062a\u063a\u0637\u064a\u0629 \u0627\u0644\u0645\u0635\u0631\u0648\u0641\u0627\u062a \u0627\u0644\u0646\u062b\u0631\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629.[et_pb_section global_module=\"274305\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u0633\u062f\u0627\u062f \u0645\u0646 Ameriflex\u200f (Ameriflex Reimbursement Claim Form)<\/h5>\n<p class=\"p1\" dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0627\u0644\u0633\u062f\u0627\u062f \u0639\u0646\u062f\u0645\u0627 \u062a\u062f\u0641\u0639 \u0645\u0642\u0627\u0628\u0644 \u0646\u0641\u0642\u0627\u062a \u0645\u063a\u0637\u0627\u0629 \u0645\u0646 \u0623\u0645\u0648\u0627\u0644\u0643 \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u062f\u0644\u0627\u064b \u0645\u0646 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0628\u0637\u0627\u0642\u0629 \u062a\u0633\u0647\u064a\u0644\u0627\u062a \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (BCC). \u064a\u0645\u0643\u0646\u0643 \u0623\u064a\u0636\u064b\u0627 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0643\u0646\u062a \u0628\u062d\u0627\u062c\u0629 \u0625\u0644\u0649 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0642\u0633\u0637\u0643 \u0627\u0644\u0634\u0647\u0631\u064a \u0627\u0644\u0635\u0627\u0641\u064a \u0644\u062e\u0637\u0629 \u0641\u0631\u062f\u064a\u0629 \u0645\u0639\u062a\u0645\u062f\u0629 \u0645\u0646 Carewell \u062a\u0645 \u0634\u0631\u0627\u0624\u0647\u0627 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0633\u0648\u0642 \u0627\u0644\u062a\u0623\u0645\u064a\u0646 \u0627\u0644\u0635\u062d\u064a.\u00a0<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/participant.myameriflex.com\/#\/login?returnUrl=https%253A%252F%252Fparticipant.myameriflex.com%252F\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p class=\"p1\" dir=\"rtl\">[et_pb_section global_module=\"294390\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0623\u0648\u0631\u0627\u0642 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare Paperwork) \u0645\u0646 Carewell<\/h5>\n<p>\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0623\u0648\u0631\u0627\u0642 \u0639\u0646\u062f \u0627\u0644\u0627\u0646\u062a\u0642\u0627\u0644 \u0644\u0623\u0648\u0644 \u0645\u0631\u0629 \u0625\u0644\u0649 \u062a\u063a\u0637\u064a\u0629 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare) \u0644\u0645\u0639\u0631\u0641\u0629 \u0645\u0627 \u0625\u0630\u0627 \u0643\u0646\u062a \u0645\u0624\u0647\u0651\u064e\u0644\u0627\u064b \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u0645\u0633\u0627\u0639\u062f\u0629 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629. <span>\u064a\u0624\u0643\u062f \u0625\u0643\u0645\u0627\u0644 \u0627\u0644\u0623\u0648\u0631\u0627\u0642 \u0641\u0647\u0645\u0643 \u0648\u0645\u0648\u0627\u0641\u0642\u062a\u0643 \u0639\u0644\u0649 \u0642\u0648\u0627\u0639\u062f \u0627\u0644\u0628\u0631\u0646\u0627\u0645\u062c \u0648\u0641\u0642\u064b\u0627 \u0644\u0642\u0648\u0627\u0639\u062f \u0627\u0644\u0635\u0646\u062f\u0648\u0642 \u0627\u0644\u0627\u0626\u062a\u0645\u0627\u0646\u064a. <\/span>\u064a\u064f\u0631\u062c\u0649 \u0627\u0644\u0639\u0644\u0645 \u0628\u0645\u0627 \u064a\u0644\u064a: \u0633\u062a\u062d\u062a\u0627\u062c \u0625\u0644\u0649 \u0645\u0644\u0621 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0645\u0631\u0629 \u0623\u062e\u0631\u0649 \u0641\u064a \u0623\u064a \u0648\u0642\u062a \u064a\u062a\u0645 \u0641\u064a\u0647 \u0625\u062c\u0631\u0627\u0621 \u062a\u063a\u064a\u064a\u0631 \u0639\u0644\u0649 \u0627\u0644\u062e\u0637\u0637.<\/p>\n<p><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212365814640049\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> \u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/a>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">Valley Insurance Professionals (VIP) \u0623\u0648\u0631\u0627\u0642 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare Paperwork)<\/h5>\n<p dir=\"rtl\"><span dir=\"rtl\">\u062a\u0645\u0646\u062d \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0627\u062a \u0641\u0631\u064a\u0642 \u0648\u0643\u0627\u0644\u0629 Valley Insurance Professionals \u0627\u0644\u0625\u0630\u0646 \u0627\u0644\u0642\u0627\u0646\u0648\u0646\u064a \u0644\u0645\u0633\u0627\u0639\u062f\u062a\u0643 \u0628\u0627\u0644\u0628\u062d\u062b \u0639\u0646 \u0627\u0644\u062e\u0637\u0629 Supplement \u0623\u0648 Advantage \u0623\u0648 Part D \u0644\u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare) \u0648\u0627\u0644\u062a\u0633\u062c\u064a\u0644 \u0628\u0647\u0627 \u0648\u0627\u0644\u062d\u0641\u0627\u0638 \u0639\u0644\u064a\u0647\u0627.<\/span><\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/212365814640049\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u00a0\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; hover_enabled=&#8221;0&#8243; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h5 dir=\"rtl\" style=\"text-align: right;\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0642\u0628\u0648\u0644 \u0628\u0627\u0644\u0625\u0641\u0631\u0627\u062c \u0639\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a (Consent to Release Information Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0631\u063a\u0628\u062a \u0641\u064a \u0627\u0644\u0633\u0645\u0627\u062d \u0644\u0623\u062d\u062f \u0645\u0646 \u0623\u0641\u0631\u0627\u062f \u0627\u0644\u0623\u0633\u0631\u0629 \u0623\u0648 \u0627\u0644\u0623\u0635\u062f\u0642\u0627\u0621 \u0628\u0637\u0631\u062d \u0627\u0644\u0627\u0633\u062a\u0641\u0633\u0627\u0631\u0627\u062a \u0648\u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0645\u0648\u0627\u0639\u064a\u062f \u0648\u062a\u0623\u0643\u064a\u062f \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0646\u064a\u0627\u0628\u0629 \u0639\u0646\u0643.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" dir=\"rtl\" href=\"https:\/\/risepartnership.jotform.com\/241904503930148?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631 (Direct Deposit Form)<\/h5>\n<p>\u0633\u062c\u0651\u0644 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0623\u0642\u0633\u0627\u0637\u0643 \u0645\u0646 \u062e\u0644\u0627\u0644 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631. \u0647\u0630\u0647 \u0647\u064a \u0627\u0644\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0623\u0633\u0631\u0639 \u0648\u0627\u0644\u0623\u0643\u062b\u0631 \u0623\u0645\u0627\u0646\u064b\u0627 \u0644\u062a\u0644\u0642\u064a \u062f\u0641\u0639\u062a\u0643. <strong>\u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u062f\u0631\u062c \u0646\u0633\u062e\u0629 \u0645\u0646 \u0634\u064a\u0643 \u0645\u064f\u0644\u063a\u0649\u060c \u0623\u0648 \u062e\u0637\u0627\u0628 \u0628\u0646\u0643\u064a \u0623\u0648 \u0628\u064a\u0627\u0646 \u062d\u0633\u0627\u0628\u0643 \u0627\u0644\u0628\u0646\u0643\u064a.<\/strong><br \/>\n[et_pb_section global_module=\"274302\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; disabled=&#8221;on&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0645\u0637\u0627\u0644\u0628\u0629 \u0628\u0633\u062f\u0627\u062f \u0623\u0642\u0633\u0627\u0637 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare Premium Reimbursement Claim Form)<\/h5>\n<p>\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0639\u0646 \u0623\u0642\u0633\u0627\u0637 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare)\u2014\u0639\u0644\u0649 \u0633\u0628\u064a\u0644 \u0627\u0644\u0645\u062b\u0627\u0644\u060c \u0627\u0644\u0623\u0642\u0633\u0627\u0637 \u0627\u0644\u0634\u0647\u0631\u064a\u0629 \u0645\u0642\u0627\u0628\u0644 \u0642\u0633\u0637 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0637\u0628\u064a\u0629 (Medicare) \u0644\u062e\u0637\u0629 Part B\u060c \u0648\u0627\u0644\u0623\u0642\u0633\u0627\u0637 \u0627\u0644\u0634\u0647\u0631\u064a\u0629 \u0644\u062e\u0637\u0637 Medicare Part D \u0623\u0648 Supplement \u0623\u0648 Advantage.<br \/>\n[et_pb_section global_module=\"274305\"][\/et_pb_section][\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\"><span style=\"color: #582c82;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 (Overpayment Notice Appeal Form)<\/span><\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 \u0645\u0646 Carewell SEIU 503.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241416905043955?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; module_id=&#8221;hcamilitaryanchor&#8221; _builder_version=&#8221;4.27.6&#8243; custom_margin=&#8221;25px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629<\/h2>\n<h3 dir=\"rtl\">\u0644\u0644\u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0645\u0631\u062a\u0628\u0637\u0629 \u0628\u0627\u0644\u062e\u062f\u0645\u0629 \u0627\u0644\u0639\u0633\u0643\u0631\u064a\u0629<\/h3>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=&#8221;4.27.6&#8243; custom_margin=&#8221;15px||||false|false&#8221; custom_padding=&#8221;3px||2px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.27.6&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;15px|15px|25px|15px|false|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0637\u0644\u0628 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 (Healthcare Cost Assistance Benefits Request Form) \u0644\u0644\u0645\u0633\u062a\u0641\u064a\u062f\u064a\u0646 \u0645\u0646 \u0627\u0644\u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0645\u0631\u062a\u0628\u0637\u0629 \u0628\u0627\u0644\u062e\u062f\u0645\u0629 \u0627\u0644\u0639\u0633\u0643\u0631\u064a\u0629<\/h5>\n<p data-pm-slice=\"1 1 []\" dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u062a\u0642\u062f\u064a\u0645 \u0627\u0644\u0645\u0633\u062a\u0646\u062f\u0627\u062a \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629 \u0644\u0637\u0644\u0628 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u062e\u0641\u0636 \u062a\u0643\u0627\u0644\u064a\u0641 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0644\u0644\u0645\u0633\u062a\u0641\u064a\u062f\u064a\u0646 \u0645\u0646 \u0645\u0632\u0627\u064a\u0627 \u0628\u0631\u0646\u0627\u0645\u062c \u0625\u062f\u0627\u0631\u0629 \u0627\u0644\u0645\u062d\u0627\u0631\u0628\u064a\u0646 \u0627\u0644\u0642\u062f\u0627\u0645\u0649 (VA)\u060c \u0623\u0648 \u0628\u0631\u0646\u0627\u0645\u062c CHAMPVA\u060c \u0623\u0648 \u0628\u0631\u0646\u0627\u0645\u062c TRICARE\u060c \u0648\u0627\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0645\u0648\u064a\u0644 \u0644\u062a\u063a\u0637\u064a\u0629 \u0627\u0644\u0645\u0635\u0631\u0648\u0641\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629 \u0627\u0644\u0646\u062b\u0631\u064a\u0629.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/260366959115868\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><span style=\"text-decoration: underline;\" dir=\"rtl\"><\/span><\/p>\n<p dir=\"rtl\"><span style=\"text-decoration: underline;\" dir=\"rtl\"><\/span><\/p>\n<p dir=\"rtl\"><span style=\"text-decoration: underline;\" dir=\"rtl\"><\/span><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;-37px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0627\u0644\u062e\u0627\u0635 \u0628\u0627\u0644\u0623\u0647\u0644\u064a\u0629 \u0648\u0627\u0644\u062a\u0639\u0648\u064a\u0636 (Eligibility and Reimbursement Appeal Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0648\u0642\u0645 \u0625\u0645\u0627 \u0628\u0645\u0644\u0621 \u0627\u0644\u062d\u0642\u0644 \u0627\u0644\u0630\u064a \u064a\u0648\u0636\u062d \u0645\u0628\u0631\u0631\u0627\u062a \u0627\u0644\u0637\u0644\u0628 \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628 \u062a\u0631\u062f \u0641\u064a\u0647 \u0627\u0644\u0623\u0633\u0628\u0627\u0628. \u0637\u0644\u0628\u0627\u062a \u0627\u0644\u062a\u0639\u0648\u064a\u0636 \u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0634\u0641\u0648\u0639\u0629 \u0628\u0648\u062b\u0627\u0626\u0642 \u062f\u0627\u0639\u0645\u0629 \u0645\u062b\u0644 \u0634\u0631\u062d \u0627\u0644\u0645\u0632\u0627\u064a\u0627 (EOB) \u0623\u0648 \u0625\u062b\u0628\u0627\u062a \u0627\u0644\u062f\u0641\u0639.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/233447328098161?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p dir=\"rtl\"><span style=\"text-decoration: underline;\" dir=\"rtl\"><\/span><\/p>\n<p>[\/et_pb_text][et_pb_code disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_margin=&#8221;20px||0px||false|false&#8221; custom_padding=&#8221;20px|15px|20px|15px|true|true&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_section global_module=\"301873\"][\/et_pb_section][\/et_pb_code][et_pb_text _builder_version=&#8221;4.27.6&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;25px|15px|25px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 dir=\"rtl\" style=\"text-align: right;\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0642\u0628\u0648\u0644 \u0628\u0627\u0644\u0625\u0641\u0631\u0627\u062c \u0639\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a (Consent to Release Information Form)<\/h5>\n<p dir=\"rtl\">\u0627\u0645\u0644\u0623 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0631\u063a\u0628\u062a \u0641\u064a \u0627\u0644\u0633\u0645\u0627\u062d \u0644\u0623\u062d\u062f \u0645\u0646 \u0623\u0641\u0631\u0627\u062f \u0627\u0644\u0623\u0633\u0631\u0629 \u0623\u0648 \u0627\u0644\u0623\u0635\u062f\u0642\u0627\u0621 \u0628\u0637\u0631\u062d \u0627\u0644\u0627\u0633\u062a\u0641\u0633\u0627\u0631\u0627\u062a \u0648\u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0645\u0648\u0627\u0639\u064a\u062f \u0648\u062a\u0623\u0643\u064a\u062f \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0646\u064a\u0627\u0628\u0629 \u0639\u0646\u0643.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" dir=\"rtl\" href=\"https:\/\/risepartnership.jotform.com\/241904503930148?language=ar\" target=\"_blank\" rel=\"noopener\"> <i class=\"fas fa-align-left\"><\/i> <span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_margin=&#8221;-37px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\"><span style=\"color: #582c82;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 (Overpayment Notice Appeal Form)<\/span><\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 \u0645\u0646 Carewell SEIU 503.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241416905043955?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text module_id=&#8221;ptoanchor&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 dir=\"rtl\">\u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631\u00a0<\/h2>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column_inner saved_specialty_column_type=&#8221;3_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0645\u0638\u0631\u0648\u0641 \u0637\u0644\u0628 \u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO Benefit Request Packet)<\/h5>\n<p dir=\"rtl\">\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0644\u062f\u064a\u0643 8 \u0633\u0627\u0639\u0627\u062a \u0623\u0648 \u0627\u0644\u0645\u0632\u064a\u062f \u0645\u0646 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO) \u0627\u0644\u0645\u062a\u0631\u0627\u0643\u0645\u0629\u060c \u0641\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0637\u0644\u0628 \u0633\u062f\u0627\u062f \u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO).<br \/>[et_pb_section global_module=\"274306\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 W-9<\/h5>\n<p>\u0644\u0627 \u0628\u062f \u0645\u0646 \u0625\u0631\u0633\u0627\u0644 \u0627\u0633\u062a\u0645\u0627\u0631\u0629 W-9 \u200f(Form W-9) \u0645\u0643\u062a\u0645\u0644\u0629 \u0648\u0645\u064f\u0648\u0642\u0651\u0639\u0629 \u0625\u0644\u064a\u0646\u0627\u060c \u0625\u0630\u0627 \u0644\u0645 \u062a\u0643\u0646 \u0642\u062f \u0642\u0645\u062a \u0628\u0630\u0644\u0643 \u0628\u0627\u0644\u0641\u0639\u0644 \u062d\u062a\u0649 \u062a\u0635\u0628\u062d \u0645\u0624\u0647\u0651\u064e\u0644\u064b\u0627 \u0644\u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO). \u064a\u064f\u0631\u062c\u0649 \u0627\u0644\u0639\u0644\u0645 \u0628\u0645\u0627 \u064a\u0644\u064a: \u062a\u064f\u0639\u062f \u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO) \u062f\u062e\u0644\u064b\u0627 \u062e\u0627\u0636\u0639\u064b\u0627 \u0644\u0644\u0636\u0631\u064a\u0628\u0629.<br \/>\n[et_pb_section global_module=\"274307\"][\/et_pb_section][\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631 (Direct Deposit Form)<\/h5>\n<p>\u0633\u062c\u0651\u0644 \u0644\u0644\u062d\u0635\u0648\u0644 \u0639\u0644\u0649 \u062a\u0639\u0648\u064a\u0636\u0627\u062a \u0623\u0642\u0633\u0627\u0637\u0643 \u0648\u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO) \u0645\u0646 \u062e\u0644\u0627\u0644 \u0627\u0644\u0625\u064a\u062f\u0627\u0639 \u0627\u0644\u0645\u0628\u0627\u0634\u0631. \u0647\u0630\u0647 \u0647\u064a \u0627\u0644\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0623\u0633\u0631\u0639 \u0648\u0627\u0644\u0623\u0643\u062b\u0631 \u0623\u0645\u0627\u0646\u064b\u0627 \u0644\u062a\u0644\u0642\u064a \u062f\u0641\u0639\u062a\u0643. <strong>\u0644\u0627 \u0628\u062f \u0623\u0646 \u062a\u062f\u0631\u062c \u0646\u0633\u062e\u0629 \u0645\u0646 \u0634\u064a\u0643 \u0645\u064f\u0644\u063a\u0649\u060c \u0623\u0648 \u062e\u0637\u0627\u0628 \u0628\u0646\u0643\u064a \u0623\u0648 \u0628\u064a\u0627\u0646 \u062d\u0633\u0627\u0628\u0643 \u0627\u0644\u0628\u0646\u0643\u064a.<\/strong><br \/>\n[et_pb_section global_module=\"274302\"][\/et_pb_section][\/et_pb_text][et_pb_text disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.23.1&#8243; text_line_height=&#8221;1.5em&#8221; background_color=&#8221;#ffffff&#8221; max_width=&#8221;1000px&#8221; module_alignment=&#8221;center&#8221; height=&#8221;100%&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#f3f3f3&#8243; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u062a\u0639\u064a\u064a\u0646 \u0627\u0644\u0645\u0633\u062a\u0641\u064a\u062f (Designation of Beneficiary Form)<\/h5>\n<p dir=\"rtl\">\u0623\u0643\u0645\u0644 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0625\u0630\u0627 \u0643\u0646\u062a \u062a\u0631\u063a\u0628 \u0641\u064a \u0627\u062e\u062a\u064a\u0627\u0631 \u0634\u062e\u0635 \u0645\u0639\u064a\u0646 \u0644\u062a\u0644\u0642\u064a \u0645\u0632\u0627\u064a\u0627 \u0627\u0644\u0625\u062c\u0627\u0632\u0627\u062a \u0645\u062f\u0641\u0648\u0639\u0629 \u0627\u0644\u0623\u062c\u0631 (PTO) \u0627\u0644\u062a\u064a \u0644\u0645 \u062a\u0637\u0627\u0644\u0628 \u0628\u0647\u0627 \u0641\u064a \u062d\u0627\u0644\u0629 \u0648\u0641\u0627\u062a\u0643.<br \/>[et_pb_section global_module=\"274308\"][\/et_pb_section]<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#ffffff&#8221; custom_padding=&#8221;15px|15px|15px|15px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h5 style=\"text-align: right;\" dir=\"rtl\"><span style=\"color: #582c82;\" dir=\"rtl\">\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0627\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 (Overpayment Notice Appeal Form)<\/span><\/h5>\n<p dir=\"rtl\">\u0627\u0633\u062a\u062e\u062f\u0645 \u0647\u0630\u0647 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 \u0644\u0644\u0627\u0633\u062a\u0626\u0646\u0627\u0641 \u0639\u0644\u0649 \u0625\u062e\u0637\u0627\u0631 \u0627\u0644\u0645\u062f\u0641\u0648\u0639\u0627\u062a \u0627\u0644\u0632\u0627\u0626\u062f\u0629 \u0645\u0646 Carewell SEIU 503.<\/p>\n<p dir=\"rtl\"><a class=\"noUnderline\" href=\"https:\/\/risepartnership.jotform.com\/241416905043955?language=ar\" target=\"_blank\" rel=\"noopener noreferrer\" dir=\"rtl\"><i class=\"fas fa-align-left\"><\/i><span style=\"text-decoration: underline;\">\u0627\u0644\u0648\u0635\u0648\u0644 \u0625\u0644\u0649 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629<\/span><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u062a\u062c\u062f \u0647\u0646\u0627 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0627\u062a \u0627\u0644\u0645\u0637\u0644\u0648\u0628\u0629 \u0644\u0644\u062a\u0633\u062c\u064a\u0644 \u0641\u064a \u0645\u0632\u0627\u064a\u0627 \u0645\u0624\u0633\u0633\u0629 Carewell SEIU 503 \u0648\u0637\u0644\u0628 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