Get Tbi Program Application - Vermont - Ddas Vermont

Filling out the TBI Program Application for Vermont's Division of Disability and Aging Services can seem overwhelming. This guide offers a clear and structured approach to assist users in completing the application accurately and efficiently.

Follow the steps to fill out the application effectively.

1. Press the ‘Get Form’ button to access the TBI Program Application and open it in your online form editor.
2. Begin with Part One of the application where you will enter your personal details such as your name, address, and contact information. Be sure to provide accurate phone numbers for day and evening availability.
3. Specify whether you are applying for the TBI Rehabilitation Program or the TBI Long Term Program. Note that inclusion in these programs typically requires that the injury occurred within the last five years.
4. Fill out the application general information section thoroughly. This includes demographic information, medical history, and specific details about your injury. It's important to articulate the nature of any deficits resulting from the injury.
5. Under the guardian/payee information section, provide any details related to a legal guardian or payee if applicable. This helps streamline communication and processing of your application.
6. Complete the insurance and income information part of the form. Be sure to indicate if you hold Medicaid or other relevant insurance, and include your Medicaid number.
7. Describe your medical information, including diagnoses and hospitalizations. List any pertinent treatments or evaluations you have previously received.
8. Ensure all required documentation is attached as specified in the form. This could include physician reports, medical records, and eligibility notifications.
9. In the release of information section, sign and date the form to indicate your agreement for the program to access your medical and personal information necessary for determining eligibility.
10. After completing all sections, review the form for accuracy. Once satisfied, save the changes, download the completed application, and prepare to submit it to the TBI Program Supervisor at the designated address.

Complete your TBI PROGRAM APPLICATION online today to begin accessing the support you need.