Form Ocfs 8000 PDF 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 training forms, ocfs forms 5451, ocfsery ocfs trainings, ocfs remote learning exemption form

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

How to Edit Form Ocfs 8000 Online for Free

Managing documents using our PDF editor is simpler as compared to anything else. To change ocfs training the form, you'll find nothing for you to do - only adhere to the actions below:

Step 1: The following website page has an orange button that says "Get Form Now". Hit it.

Step 2: Now, you can begin modifying your ocfs training. The multifunctional toolbar is at your disposal - add, delete, alter, highlight, and perform several other commands with the content in the document.

These sections will create the PDF document that you'll be creating:

ocfs 5014 s form empty fields to consider

Write down the details in the MEDICAL CONSENTER NAME, RELATIONSHIP TO CHILD, MEDICAL CONSENTER ADDRESS, CITY, STATE, ZIP CODE, PHONE, LOCAL DEPARTMENT OF SOCIAL, DIVISION OF JUVENILE JUSTICE AND, CONTACT INFO Check One, CONTACTS NAME, CONTACTS TITLE, CONTACTS SIGNATURE X, DATE, and PHONE area.

ocfs 5014 s form MEDICAL CONSENTER NAME, RELATIONSHIP TO CHILD, MEDICAL CONSENTER ADDRESS, CITY, STATE, ZIP CODE, PHONE, LOCAL DEPARTMENT OF SOCIAL, DIVISION OF JUVENILE JUSTICE AND, CONTACT INFO Check One, CONTACTS NAME, CONTACTS TITLE, CONTACTS SIGNATURE X, DATE, and PHONE blanks to complete

Step 3: Select "Done". You can now transfer the PDF file.

Step 4: Make duplicates of your file - it may help you refrain from potential future complications. And don't get worried - we do not share or check your details.

Watch Form Ocfs 8000 Video Instruction

Form Ocfs 8000 isn’t the one you’re looking for?

Related Documents

  • Form No Cms R 131 G

    "... Patient name, medicare hi-cn notice to the beneficiary abn. You have the right to choose whether you would like to be covered by medicare. If you do not want these items/services to be paid for ..."

  • Form Nursing Notes

    "... 25 1856.127 lj gh wh 285 020 59 216 Fox gh Ph gl Qd qg Wu hd Wp Hq Haq Gl 1856.127 17 21 Ru hg Riz Uru Uw Ul ww Huq Hq Wol vw ..."

  • Form Oc 110A

    "... State of New York Workers Compensation Board Instructions Submit original to workers compensation boards and keep a copy for your records. Authorization to disclose records is invalid under section 110. ..."

  • Form Ocfs 3909

    "... Cfs 3909 Rev 04 2009 Front New York State Office of Children and Family Services Request for Information Guardianship Form for Court Use Only Cr use Only request resource id code court liaison Area Code ..."

Please rate Form Ocfs 8000

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .