Ocfs Training Forms Details

Are you looking for a new way to track your monthly expenses? If so, you may want to consider using Form Ocfs 8000. This form is designed to help you keep track of your spending each month, and it can be a great way to stay on top of your finances. In this post, we'll discuss what Form Ocfs 8000 is and how you can use it to improve your financial situation. We'll also provide a few tips on how to fill out the form correctly.

This page holds information about form ocfs 8000. Our advice is that you check out this information before you decide to start working with the file.

QuestionAnswer
Form NameForm Ocfs 8000
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesocfs forms 5451, ocfs training, ocfs ccfs le 008 form, ocfs forms ny

Form Preview Example

OCFS-8000 (1/2011)

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

REFERRAL FORM

BRIDGES TO HEALTH (B2H) HOME & COMMUNITY BASED SERVICES MEDICAID WAIVER PROGRAM

CHILD’S NAME (LAST, FIRST, MI,):

DATE OF BIRTH:

SEX:

 

 

MEDICAID CIN #:

 

Male

Female

 

 

 

 

 

 

 

B2H WAIVER TYPE (Check one only)

 

REFERRAL TYPE (Check one only)

B2H Serious Emotional Disturbance (SED) Waiver

Initial Referral

B2H Developmental Disabilities (DD) Waiver

 

Subsequent Referral: completed if child name is on Wait List

B2H Medically Fragile (MedF) Waiver

 

 

 

 

 

 

 

 

A list of Health Care Integration Agencies was provided to the child/medical consenter. The child/medical consenter has selected the following agency:

HEALTH CARE INTEGRATION AGENCY NAME:

 

PHONE #:

 

 

 

 

 

HEALTH CARE INTEGRATION AGENCY ADDRESS:

CITY:

STATE:

ZIP CODE:

 

 

 

 

HEALTH CARE INTEGRATION AGENCY STAFF CONTACT NAME:

 

 

 

 

 

 

 

The

 

has determined that the child

 

LOCAL DEPARTMENT OF SOCIAL SERVICES (LDSS) OR DIVISION OF JUVENILE JUSTICE AND

 

OPPORTUNITIES FOR YOUTH (DJJOY)

identified above would benefit from the services offered by the B2H Medicaid Waiver Program. The child is Medicaid eligible. For a child in LDSS custody, we have assigned a role to their CONNECTIONS Family Services Stage.

To assist in your assessment of the child’s suitability for the B2H Medicaid Waiver Program, we have included the following items:

Authorization for Release of Information form(s), (OCFS-8001)

B2H Medicaid Waiver Program Qualifying Diagnosis(es) and supporting documentation.

For a Subsequent Referral, all information from Initial Referral and Initial Application is included.

MEDICAL CONSENTER NAME:

 

RELATIONSHIP TO CHILD:

 

 

 

 

 

 

 

 

MEDICAL CONSENTER ADDRESS:

CITY:

 

STATE:

ZIP CODE:

PHONE #:

 

 

 

 

 

 

LOCAL DEPARTMENT OF SOCIAL SERVICES OR

DIVISION OF JUVENILE JUSTICE AND OPPORTUNITIES FOR YOUTH (DJJOY)

CONTACT INFO (Check One)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT’S NAME:

 

CONTACT’S SIGNATURE:

 

 

 

 

DATE:

 

 

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT’S TITLE:

 

 

 

 

 

PHONE #:

 

 

 

 

 

 

 

 

 

 

CONTACT’S ADDRESS:

 

 

CITY:

COUNTY:

 

STATE:

ZIP CODE:

 

 

 

 

 

 

 

 

 

 

Original – Health Care Integration Agency; Copy of 8000 Form Only – Child/Medical Consenter, Caregiver, Case Planning Agency, OCFS Quality Management Specialist; Copy of 8000 Form and Supporting Documentation - Local Department of Social Services or Division of Juvenile Justice and Opportunities for Youth

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