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NEW MEXICO HIV SERVICES A.D.A.P. INSURANCE ASSISTANCE PROGRAM RECERTIFICATION FORM First: MI: Nick Name: Last: SSN: DOB: Mailing Address: Mail: Yes City: Phone: E State: Zip: OK to call: Yes No (circle
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Start by reading through the form carefully to understand the information requested and the sections that need to be completed.
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Provide your personal information accurately in the designated fields. This may include your name, contact details, and any other required identifying information.
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Move on to the section that requires you to provide your current certification details. If you have a previous certification, enter the relevant information accurately.
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Complete any sections related to your recertification eligibility. This may include indicating the duration of your certification, any continuing education or training completed, and any additional requirements specific to your certification.
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Review the form once all the required sections are completed to ensure accuracy and completeness.
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Sign and date the form as instructed.
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It is a form used for recertification of the Adaptive Behavior Assessment System.
Educators and professionals working with individuals with disabilities.
The form must be completed with accurate information about the individual's adaptive behavior.
The purpose is to assess and track the adaptive behavior of individuals over time to provide appropriate support and interventions.
Information such as the individual's name, demographic details, adaptive behavior scores, and any changes in behavior or progress.
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