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SERVICE PROVIDER APPLICATION 2023 Home and CommunityBased Settings (HCBS) Funding Opportunity FY20222023 Please complete all sections on the application. In complete applications will not be considered.
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How to fill out early start referral form
How to fill out early start referral form
01
Obtain the early start referral form from the appropriate agency or organization.
02
Fill out the child's personal information including name, date of birth, and contact information.
03
Provide details about the child's developmental concerns and any relevant medical history.
04
Include information about the family and any services or support currently being received.
05
Sign and date the form, ensuring all sections are complete and accurate.
06
Submit the form to the designated contact or agency as directed.
Who needs early start referral form?
01
Parents or guardians of children who may have developmental delays or disabilities.
02
Healthcare professionals or educators who work with children and suspect developmental concerns.
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What is early start referral form?
The Early Start Referral Form is a document used to initiate the early intervention process for children suspected of having developmental delays or disabilities.
Who is required to file early start referral form?
The early start referral form is typically filed by parents, guardians, or authorized individuals such as pediatricians or service providers who suspect that a child may need early intervention services.
How to fill out early start referral form?
To fill out the early start referral form, you need to provide the child's personal information, description of concerns regarding the child's development, and consent for evaluation and services.
What is the purpose of early start referral form?
The purpose of the early start referral form is to identify children who may need early intervention services and to facilitate the evaluation process to determine their eligibility for support.
What information must be reported on early start referral form?
The form must include the child's name, date of birth, parent/guardian contact information, a description of developmental concerns, and permission for evaluation.
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