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PCI Staff Only Case ID#___An Affiliate of Texas Early Childhood Intervention www.dars.state.tx.us/ecis Little Lives PCI Betty Hardwick PCI Central Texas MMR PCI 1104 Henderson St 765 Orange St PO
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How to fill out screeningevaluation cover sheet

01
Fill in the patient's personal information such as name, date of birth, address, and contact information.
02
Include the date that the screening evaluation was conducted.
03
Provide details about the patient's medical history and any relevant information that may impact the evaluation.
04
Clearly mark any risk factors or concerns that need to be highlighted during the screening evaluation.
05
Obtain necessary signatures from the patient, healthcare provider, and any other relevant parties involved in the evaluation.

Who needs screeningevaluation cover sheet?

01
Healthcare providers conducting screenings or evaluations for patients.
02
Organizations or institutions requiring documentation of screenings for compliance or record-keeping purposes.
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The screeningevaluation cover sheet is a form used to provide a summary of screening or evaluation results.
All individuals or entities required to conduct screening or evaluation are required to file the screeningevaluation cover sheet.
The screeningevaluation cover sheet can be filled out by providing the necessary information requested on the form.
The purpose of the screeningevaluation cover sheet is to provide a concise summary of screening or evaluation results.
The screeningevaluation cover sheet must report details of the screening or evaluation conducted, including any findings or results.
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