Systems and Procedures
A Division of The Corporate Controller's Office

HD2007-Exhibits

EXHIBIT A

Fee Waiver (University Program)

Image of Exhibit A - Fee Waiver (University Program)

EXHIBIT B

Fee Waiver (Speech or Audiology Program)

Image of Exhibit B - Fee Waiver (Speech or Audiology Program

EXHIBIT C

Services Record/Billing Form

Image of Exhibit C - Services Record/Billing Form

EXHIBIT D

Outpatient Referral Request Form

Image of Exhibit D - Outpatient Referral Request Form

EXHIBIT E

Authorization Order

Image of Exhibit E - Authorization Order

EXHIBIT F

OVR-208 Invoice

Image of Exhibit F - OVR-208 Invoice

EXHIBIT G

Sales Summary and Cash Reconciliation

Image of Exhibit G - Sales Summary and Cash Reconciliation