Get Clbc Eligibility Assessment Summary Form - Community Living ...

This guide provides a clear and supportive walkthrough for filling out the CLBC Eligibility Assessment Summary Form online. Whether you have prior experience or are new to digital document management, this comprehensive outline will assist you in completing the form accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the CLBC Eligibility Assessment Summary Form and open it in your preferred online document editor.
2. Begin by entering the assessment summary information for the individual in the designated fields, including their last name, first name, middle name, and date of birth.
3. In Section A, indicate whether the individual meets the DSM-IV-TR criteria for mental retardation by checking the appropriate box.
4. If applicable, proceed to Section B to indicate any other eligibility criteria met, such as a diagnosis of a pervasive developmental disorder. Fill in the necessary details including the diagnosis and the name and date of the qualified specialist who made the diagnosis.
5. Continue by entering details about the assessment regarding Fetal Alcohol Spectrum Disorder. Ensure accurate naming of the medical and registered practitioners involved along with the dates of their formal reports.
6. Assess and document the individual's limitations in adaptive functioning, providing scores from the relevant measures as necessary.
7. The qualifying practitioner must attest to the individual's limitations by signing and providing their name, address, phone number, email, and registration number.
8. In the Release of Information section, have the individual provide their consent with their signature and print name, alongside their address details.
9. Once all sections are properly filled out, review the entire form for any errors or missing information before proceeding to save, download, print, or share the completed document.

Complete your CLBC Eligibility Assessment Summary Form online today to ensure timely processing of services.