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SHC
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Group D Retirement
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Submit an ADO: How-to Info
Nurse Advocate Request
Consent to Serve form 2022-2025 term
Other forms
Contact
Request a Nurse Advocate
Contact
Form testing
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Name
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Hospital (check one):
SHC
LPCH
Unit name
Type of expense
Food (webinar expense only)
Unit supplies (specify)
Description of expense
Date expense incurred
MM slash DD slash YYYY
(Maximum reimbursement is $75 monthly)
Type of expense
Food (webinar expense only)
Supplies (specify)
Other (specify)
Description of expense
Date expense incurred
MM slash DD slash YYYY
(Maximum reimbursement is $75 monthly)
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Max. file size: 256 MB.
Date of expense and amount of expense must be clearly readable. Unreadable receipts may not be accepted.
Signature
(Required)
I certify that all expenses were incurred in the fulfillment of my role as a CRONA Area Representative. I understand that I may not be reimbursed for purchases that are for my personal use, with the exception of purchasing food to be consumed by me on the evening of the monthly Area Representative/membership webinar. All expenses are subject to review by the CRONA Treasurer.
(Required)
I agree to terms and conditions
(Required)
I certify that all expenses were incurred in the fulfillment of my role as a CRONA Area Representative. I understand that I may not be reimbursed for purchases that are for my personal use, with the exception of purchasing food to be consumed by me on the evening of the monthly Area Representative/membership webinar. All expenses are subject to review by the CRONA Treasurer.
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