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NWAuthForm_tcm36-8851.pdf

2/28/2011168.5 KB

Instructions How to fill out “Authorization for Kaiser Permanente to Use/Disclose Protected Health Information” form If not complete, form may be sent back to you http://hr2.chevron.com/Images/NWAuthForm_tcm36-8851.pdf

AttendingPhysicianStatement_tcm36-8835.pdf

9/1/2016164.5 KB

Reed Group P.O. Box 6248 Broomfield, CO 80021 Fax: 720-279-6783 Toll-Free Fax: 1-866-828-4967 Phone: 1-888-825-5247, option 5 Page 1 of 3 Chevron APS Chevron http://hr2.chevron.com/Images/AttendingPhysicianStatement_tcm36-8835.pdf

Behavioral_Health_APS_tcm36-8836.pdf

2/27/201336.6 KB

INSTRUCTIONS: The following evaluation form must be completed by the employee’s physician or health care provider The purpose of this report is to assist us in making a disability http://hr2.chevron.com/Images/Behavioral_Health_APS_tcm36-8836.pdf

FMLAMedCertPersonal_tcm36-8845.pdf

11/15/201671.4 KB

CERTIFICATION OF HEALTH CARE PROVIDER FOR MEDICAL LEAVE Family and Medical Leave Act of 1993 (“FMLA Employee’s Statement: To be completed by EMPLOYEE a request for FMLA due to your http://hr2.chevron.com/Images/FMLAMedCertPersonal_tcm36-8845.pdf

FMLAMedCertFamily_tcm36-8842.pdf

1/2/200967.4 KB

Reed Group P.O. Box 6248 Broomfield, CO 80021 Fax: 720-279-6783 Phone: 888-825-5247, option 5 Certification of Health Care Provider for Medical Leave If leave is requested for the http://hr2.chevron.com/Images/FMLAMedCertFamily_tcm36-8842.pdf

FMLAMedCertMilitaryFamilyLeave_tcm36-8844.pdf

1/2/200954.0 KB

Reed Group P.O. Box 6248 Broomfield, CO 80021 Fax: 720-279-6783 Phone: 888-825-5247, option 5 Certification of Qualifying Exigency for Military Family Leave A copy of a bill for http://hr2.chevron.com/Images/FMLAMedCertMilitaryFamilyLeave_tcm36-8844.pdf

FMLAMedCertMilitaryCaregiverLeave_tcm36-8843.pdf

1/2/200960.3 KB

Reed Group P.O. Box 6248 Broomfield, CO 80021 Fax: 720-279-6783 Phone: 888-825-5247, option 5 Certification for serious Injury or Illness of Covered Servicemember for Military http://hr2.chevron.com/Images/FMLAMedCertMilitaryCaregiverLeave_tcm36-8843.pdf

2018MHSAHDHP_020_tcm36-7115.pdf

9/19/2017412.3 KB

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Chevron Mental Health & Substance Abuse Plan http://hr2.chevron.com/Images/2018MHSAHDHP_020_tcm36-7115.pdf

2018MHSAGloChoiceUSPayExpat_012_tcm36-7101.pdf

9/19/2017420.7 KB

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Chevron Mental Health & Substance Abuse Plan http://hr2.chevron.com/Images/2018MHSAGloChoiceUSPayExpat_012_tcm36-7101.pdf