ࡱ> 796 bjbj:: "PPZCCCCCWWWW8W((%C CC   CC   CC !%(BW <d0 g g  C  :    Texas A&M University-KingsvilleCAF 2Sample Medical Facility Notification Letter Each Camp or Youth Outreach Program must send this letter to the designated medical facility as provided on the camp/program application (see 4/6/3 of University Standard Administrative Procedure 11.99.99.K1.01: Camp and Youth Outreach Program Procedures). Date & send 2-3 weeks before program Mr. Steven Daniel CHRISTUS Spohn Hospital Kleberg 1311 General Cavazos Blvd. Kingsville, TX 78363 Dear Mr. Daniel, This is to notify you that the (name of camp or program) will be conducting activities on the Texas A&M University-Kingsville campus during the period of (dates of camp or program) and that in the event of a medical emergency, members of this group may be sent to (name of medical facility) to receive medical care. The (name of camp or program) participants are covered under a group accident medical insurance policy with Summit America Insurance Services. Bills for medical care provided to camp participants for the period indicated above should be sent to: Summit America Insurance Services 7400 College Blvd., Ste. 100 Overland Park, KS 66210 Phone: (877) 246-6997 FAX: (913) 327-7520 To check status of a claim once it has been filed, you may call: (877)246-6997 Sincerely, Name of University Camp Sponsor Phone number CC: Enterprise Risk Management, Lewis Hall Room 133;  HYPERLINK "mailto:Randolph.creel@tamuk.edu" Randolph.creel@tamuk.edu     Page  PAGE 1 of  NUMPAGES 1 This form adapted from TAMU Camp form. )UVcqX Y ` } ~  6  @ X y z 3   2 B x ˽{sh[{h 5h[{h 5\ h CJ h >* h[{h hsMh 6B*phh 6B*phh h 6B*]phwwwhoph 6B*]phwwwhoph B*phwwwhsMh :B*aJphwwwhEh :B*aJphwwwh :B*aJphwww,"()UVX Y Z yqllc $@&a$gd $a$$a$gd tkd$$IflF," 4X t6    44 lap $Ifgd $If 2 3     2 A B gd $a$gd  $@&a$gd $a$gd $a$x y źպh CJaJmHnHujh-h CJUaJh-h CJaJh CJaJjh Uh h#Ph 0J6]h 6B*]phwwwjh 6B*U]phwww $a$gd $a$gd ^gd gd  1h/ =!"#$%$$If!vh5 545X#v #v4#vX:V l t65 545X/ / p2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~8XV~PJ_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 6>@6 Title$a$ 5CJ\4B@4 Body Text$a$6U`6 yK Hyperlink >*B*ph4@"4 -Header  !4 @24 -Footer  !jCj - Table Grid7:V0ZYRZ Z Document Map-D M CJOJQJ^JaJPK![Content_Types].xmlj0 u$Nwc$ans@8JbVKS(.Y$8MVgLYS]"(U֎_o[gv; f>KH|;\XV!]օ Oȥsh]Hg3߶PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. DKfN1엓:+ۥ~`jn[Zp֖zg,tV@bW/Oټl6Ws[R?S֒7 _כ[֪7 _w]ŌShN'^Bxk_[dC]zOլ\K=.:@MgdCf/o\ycB95B24S CEL|gO'sקo>W=n#p̰ZN|ӪV:8z1f؃k;ڇcp7#z8]Y / \{t\}}spķ=ʠoRVL3N(B<|ݥuK>P.EMLhɦM .co;əmr"*0#̡=6Kր0i1;$P0!YݩjbiXJB5IgAФ޲a6{P g֢)҉-Ìq8RmcWyXg/u]6Q_Ê5H Z2PU]Ǽ"GGFbCSOD%,p 6ޚwq̲R_gJS֣9)嗛(:/ak;6j11太x~<:ɮ>O&kNa4dht\?J&l O٠NRpwhpse)tp)af] 27n}mk]\S,+a2g^Az )˙>E G鿰L7)'PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 /_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!\theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  11YYY\x    xX!,.\!8@0(  B S  ?i1B "()@p@UnknownGTimes New Roman5Symbol3 Arial;|i0Batang5@$mffoTahoma"1hi*F  !4H2QHX?{2!xx+SAMPLE MEDICAL FACILITY NOTIFICATION LETTERKAZ james pollock Oh+'0 ( L X d p|',SAMPLE MEDICAL FACILITY NOTIFICATION LETTERKAZ Normal.dotmjames pollock2Microsoft Macintosh Word@F#@&䁏@6 B@6 B ՜.+,D՜.+,l( hp  'Texas A&M University  ,SAMPLE MEDICAL FACILITY NOTIFICATION LETTER Title 8@ _PID_HLINKS'AxCF mailto:Randolph.creel@tamuk.edu  !"#$%'()*+,-/0123458Root Entry Fx%(B:Data 1TablegWordDocument"SummaryInformation(&DocumentSummaryInformation8.CompObj` F Microsoft Word 97-2004 DocumentNB6WWord.Document.8