stickdog ,asher and josh ...filmed with sprained ankle so dont tease my filmin.... filed with vx2000 sony raynox mx3000 pro fisheye ...
this is my first day with new vx2000 vx2000e vx2k and raynox mx3000 (shit lens) just at goulburn skate park and some street ...
The repair of my broken Samsung VP-D364W camcorder. Please write a comment if the video is helps you in any way! Thank you!
State of California--Health and Human Services Agency
Department of Health Care Services California Children's Services/Genetically Handicapped Persons Program
ESTABLISHED CCS/GHPP CLIENT SERVICE AUTHORIZATION REQUEST (SAR)
1. Date of request 4. Address (number, street) 5. Contact person 2. Provider name City 6. Contact telephone number 3. Provider number State ZIP code
7. Contact fax number
( ) Client Information
8. Client name--last 9. Gender First 10. Date of birth (mm/dd/yyyy) Middle
11. CCS/GHPP case number
13. Client's Medi-Cal number
12. Client index number (CIN)
15. Service Authorization Request for (Check one)
a. CCS/GHPP New SAR b. Authorization extension (If checked, enter authorization number: Requested Services
16.* CPT-4/ HCPCS Code/NDC 17. Specific Description of Service/Procedure 18. From (mm/dd/yy) To (mm/dd/yy)
19. Frequency/ Duration 20. Units 21. Quantity
* A ...