NY OCFS-LDSS-4433 2019-2025 free printable template
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OCFSLDSS4433 (Rev. 5/2014) FRONTIER YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICESCHILD IN CARE MEDICAL STATEMENT
To Be Completed By Licensed Physician, Physicians Assistant or Nurse Practitioner
Name
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How to fill out NY OCFS-LDSS-4433
01
Obtain the NY OCFS-LDSS-4433 form from the appropriate New York State Office of Children and Family Services website or your local Department of Social Services.
02
Read the instructions carefully before starting to fill out the form.
03
Enter the date at the top of the form.
04
Fill in the personal information section, including your name, address, and contact details.
05
Provide the details of the child or children involved, including their names, dates of birth, and any relevant identification numbers.
06
Complete the section regarding the reason for the request, specifying what information or services you are seeking.
07
If needed, include any additional information or documentation that supports your request.
08
Review the completed form for accuracy and completeness.
09
Sign and date the form at the designated area.
10
Submit the form according to the provided instructions, which may include mailing it to a specific address or delivering it in person.
Who needs NY OCFS-LDSS-4433?
01
Individuals or guardians seeking information or services related to child welfare.
02
Parents or caregivers of children who require services provided by the Office of Children and Family Services.
03
Any person who is involved in a child custody case and needs to document their situation.
04
Social service professionals who need to refer clients for specific services.
05
Organizations working with children and families may also need to fill out this form as part of their procedures.
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What is NY OCFS-LDSS-4433?
NY OCFS-LDSS-4433 is a New York State document used for reporting certain information related to child welfare and family services.
Who is required to file NY OCFS-LDSS-4433?
Entities that are mandated reporters, such as social workers, educators, medical professionals, and law enforcement officers, are required to file NY OCFS-LDSS-4433.
How to fill out NY OCFS-LDSS-4433?
To fill out NY OCFS-LDSS-4433, gather required information about the child and family involved, complete all sections of the form accurately, and submit it to the appropriate local office.
What is the purpose of NY OCFS-LDSS-4433?
The purpose of NY OCFS-LDSS-4433 is to document and report instances of child abuse, neglect, or maltreatment in order to facilitate investigations and intervention.
What information must be reported on NY OCFS-LDSS-4433?
NY OCFS-LDSS-4433 must include information such as the details of the incident, the identities of the involved parties, and any relevant observations or evidence.
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