Fillable HCRAcknowledgement Form ADMINISTRATIVE SERVICES

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HCRAcknowledgement Form ADMINISTRATIVE SERVICES

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HUMAN RESOURCES
· Insurance Benefits ·
Cuesta College Insurance Benefits • PO Box 8106 • San Luis Obispo, CA 93403-8106
Phone 805-546-3161 • Fax 805-546-3906 • Stephanie_vieira@cuesta.edu
Acknowledgement of Health Care Reform Model Notice
I acknowledge that I have received a copy, read and understand the Health Care
Reform Model Notice:
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HCRAcknowledgement Form ADMINISTRATIVE SERVICES

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Completed 15 November 2019

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