As a community service, the Library makes its Community Room available for use by nonprofit and civic groups when it is not being used for Library-related activities. The Library also makes selected other spaces available for reservation including the children’s Area, teen Area, Study Room, Michigan Room and Literacy Room. Separate applications are provided for those reservations with all Community Room policies applying to those spaces.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, and sample consent to treat form.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, sample consent to treat form, sample accommodation request for healthcare appointments.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, and sample consent to treat form.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, sample consent to treat form, sample accommodation request for healthcare appointments.
In this booklet, you will find recorded information on decisions that I have made in advance to help you during this time.
If you will give this booklet to my funeral director, everything can be conducted in accordance with my written wishes. I believe that this effort will minimize the emotional strain that you are in at this time.
In this booklet, you will find vital statistics, estate information, funeral or cremation arrangements and other important information. I hope this, in someway, relieves you from the anxiety and burden of making these decisions at a very difficult time.
In this booklet, you will find recorded information on decisions that I have made in advance to help you during this time.
If you will give this booklet to my funeral director, everything can be conducted in accordance with my written wishes. I believe that this effort will minimize the emotional strain that you are in at this time.
In this booklet, you will find vital statistics, estate information, funeral or cremation arrangements and other important information. I hope this, in someway, relieves you from the anxiety and burden of making these decisions at a very difficult time.
1. 227 E. State St. ~ Hastings, MI 49058 Phone: 269-945-4263 ~ Fax: 269-948-3874
E-Mail: has@llcoop.org http://www.hastingpubliclibrary.org
Application for Use of Community Room
1) Groups wishing to reserve the meeting room should submit a completed application at the
Circulation Desk.
2) Please allow two (2) weeks prior to your selected meeting date for the application to be
processed.
3) Tentative bookings may be made by telephone, but written application is required for
confirmation within 24 hrs of the phone call.
Name of Organization __________________________________________________________
Address _____________________________________________________________________
Contact Person ________________________________ Phone _______________________
HPL Applicant ___________________________________ Card No: 2134800______________
Content of Program ___________________________________________________________
Date Requested ____________ Time Requested ____________ to _____________________
Your reservation will be held one-half hour past the scheduled time before it is released for other
uses.
Cancellation Policy: The Library should be notified about cancellations no later than 24 hours prior to
the event. A cancellation fee of $10 will be charged for failure to cancel a reservation and no
further reservations will be honored until the fee is paid.
How many persons to you expect to attend? ___________________
Will you need: _____ ½ room (23’ x 28’) ____ entire room (46’ x 28’)
Will you be serving food/beverage? No ______ Yes _____ $10.00 fee due with application
Do you need any of the following?
Audio hook up _____ DVD player _____ Power Point projection connection for your laptop ____
Chairs - # ________ Tables - # ______
Would you like the room set up? If so we need you, on the back of this page, to draw the room
exactly the way you expect to find it. If you do not specify an arrangement for the chairs and
tables they will be placed in the room for you to arrange.
To help us better understand who is using the facility please check one to identify your group:
Service group Corporate Meeting Non-Governmental Organization
Governmental Organization Library Event Friends of the Library Event
I have read the attached Hastings Public Library Community Room Policy and agree to comply with that
policy.
Name _____________________________________ Date__________________________
After your event, please let the staff member at the Customer Service desk know the
number of participants.
S:FormsProgram related forms