N.H. Code Admin. R. Saf-C 7803.03 – Application Requirements

(a) The applicant shall complete and submit the “Application for Medical Evaluation Reimbursement” form, dated 12/2020.
(b) The applicant shall include the following documentation with the “Application for Medical Evaluation Reimbursement” form:
1. (1) A completed and signed copy of the “Occupational Health Provider Verification” form, dated 12/2020; and
2. (2) A legible itemized paid receipt from the occupational healthcare provider.
(c) The above documentation shall be submitted to the division within 60 days of the date of the medical examination.
(d) If the medical examination occurred after July 17, 2019 but prior to the effective date of this chapter, the above documentation shall be submitted no later than 60 days after the effective date of this chapter.
(e) Notwithstanding any rule to the contrary, applicants shall apply for reimbursement of medical examinations during the state fiscal year with termination of reimbursement for eligible costs at the end of the fiscal year on June 30.
Source. #13161, eff 1-21-21
APPENDIX A
Rule Number
Statute Implemented
Saf-C 7801.01 – 7801.02
RSA 281-A:17, II (d); RSA 541-A:7
Saf-C 7802.01 – 7802.06
RSA 281-A:17, II (d); RSA 541-A:7
Saf-C 7803.01 – 7803.03
RSA 281-A:17, II (d); RSA 541-A:7
APPENDIX B
Rule
Title
How to Obtain:
Saf-C 7802.04
Saf-C 7802.05
National Fire Protection Association, (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments
National Fire Protection Association
1 Batterymarch Park
Quincy, Massachusetts
USA 02169-7471
Tel: 800.344-3555
Fax: 800.593-NFPA
https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and-standards/detail?code=1582
On-line access. Free of charge
Hard Copy Cost: $67.50