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To be faxed to the referring provider/agency and to the Medical Home at completion of children assessment EARLY INTERVENTION FEEDBACK TO THE MEDICAL HOME (Birth to 5)To be completed by the referring
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To fill out a document to be faxed, follow these steps:
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Who needs to be faxed to?

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The document needs to be faxed to the intended recipient or organization specified by the fax instructions.
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Common recipients who may require faxed documents include:
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Make sure to double-check the instructions provided to determine the correct recipient for the faxed document.

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To be faxed to a specific fax number provided by the recipient.
The person or entity requested by the recipient is required to file to be faxed to.
To fill out to be faxed to, follow the instructions provided by the recipient and include all necessary information.
The purpose of to be faxed to is to provide important information or documents to the recipient in a timely manner.
The information that must be reported on to be faxed to will depend on the specific requirements of the recipient.
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