Note: As of 8/29/08, the following form is being revised and will be posted as soon as it is complete:
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J RAC Project
Funding
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Request for
Proposal
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Updated
8/08
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Application for
Project Funding
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Updated
8/08
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Criteria for J RAC
Grant
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Updated
8/08
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Expenditure Summary
for J RAC Grant
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Updated
8/08
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Texas J RAC Needs
Assessment
Fiscal Year 2009 |
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Updated
6/08
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Other Funding
Forms
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EMS/County Report of
Expenditures -
911/1131/3588 Funds Fiscal Year 2008 |
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Performance
Improvement Forms
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EMS Summary
Report
effective December 21, 2007 |
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EMS Data Form
effective December 21, 2007 |
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Hospital Summary
Report
effective December 21, 2007 |
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Hospital Data
Form
effective December 21, 2007 |
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Occurence-Problem
Form
effective December 21, 2007 |
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First Responder
Yearly Status Form
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PI Committee
Statement of Nondisclosure
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Physician Advisory
Committee Case Review
effective December 21, 2007 |
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Bioterrorism
Forms
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HSR 9/10 Treatment Center
Sites & Contact Information |
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Hospital Planning
Guidelines
Acknowledgement of Receipt |
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Expenditure Sheet
Instructions
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Hospital Planning
Group
Quarterly Progress Report |
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Hospital Planning
Group
Quarterly Expenditure Report Instructions |
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List of All
Forms |
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| Project Funding | ||
| Request for Proposal | ||
| Application for Project Funding | ||
| Criteria for J RAC Grant | ||
| Expenditure Summary for J RAC Grant | ||
| Texas J RAC Needs
Assessment Fiscal Year 2009 |
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| Other Funding Forms | ||
| EMS/County Report of
Expenditures - 911/1131/3588 Funds Fiscal Year 2007 |
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| PI Forms | ||
| EMS Summary Report effective December 21, 2007 |
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| EMS Data Form effective December 21, 2007 |
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| Hospital Summary
Report effective December 21, 2007 |
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| Hospital Data Form effective December 21, 2007 |
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| Occurrence-Problem
Form effective December 21, 2007 |
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| First Responder Yearly Status Form | ||
| PI Committee Statement of Nondisclosure | ||
| Physician Advisory
Committee Case Review Form effective December 21, 2007 |
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| Bioterrorism Forms | ||
| HSR 9/10 Treatment Center Sites & Contact Information |
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| Hospital Planning
Guidelines Acknowledgement of Receipt |
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| Expenditure Sheet Instructions | ||
| Hospital Planning
Group Quarterly Progress Report |
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| Hospital Planning
Group Quarterly Expenditure Report Instructions |
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| Other Forms | ||
| Texas J RAC Expense Report | ||
| Texas J RAC Board of
Directors Designation of Representative |
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| Affidavit Acknowledging
Utilization of Protocols - Hospital |
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| Affidavit Acknowledging
Utilization of Protocols - EMS |
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| EMS Information Form | ||
| Hospital Information Form | ||
| MOA For Mutual Aid of EMS for Public Assistance to Provide Mutual Aid | ||
| HSR 9-10 Sites & Contact Information | ||
| Uncompensated Trauma Care Application due 3/07 | ||
| Distribution Plan for 911 County Funds | ||
| Distribution Plan Agreement for 911 County Funds (Plan A) | ||
| NIMS Tracking Form | ||
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Other
Forms |
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Texas J RAC Board
of Directors Designation of Representative |
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Affidavit
Acknowledging Utilization of Protocols - Hospital |
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Affidavit
Acknowledging Utilization of Protocols - EMS |
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EMS Information
Form |
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Hospital
Information Form |
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MOA For Mutual Aid of EMS for Public Assistance to Provide Mutual Aid |
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HSR 9-10 Sites & Contact Information |
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Uncompensated Trauma
Care Application due 3/07 |
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Distribution Plan for 911 County Funds |
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Distribution Plan Agreement for 911 County
Funds (Plan A) |
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NIMS Tracking Form |
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