Get Victimcomp Da18 State Co Us

Filling out the VictimComp Da18 form online is an essential step in seeking assistance through the Crime Victim Compensation Board. This guide will help you navigate the process seamlessly and ensure you provide all necessary information accurately.

Follow the steps to complete your VictimComp Da18 form effectively.

1. Click ‘Get Form’ button to access the VictimComp Da18 form and open it in the provided editor.
2. Enter the date at the top of the form to record when you are completing it.
3. Fill in the client information section, including the client's name, address, telephone number, and current living situation.
4. Provide the therapist's information, including their name, address, telephone number, and license number and type.
5. If applicable, include the parent or guardian's details as well as the supervisor's information if the therapist is in training.
6. Detail the insurance information by indicating whether the client has insurance, including the insurance company name, telephone number, and policy number.
7. In the treatment section, briefly describe the victimization, including the date of the crime, the perpetrator's name, and the reporting law enforcement agency.
8. Describe the client’s current symptoms that are directly connected to their victimization.
9. Outline specific treatment goals related to the victimization.
10. Check all applicable treatment modalities that will be used to achieve the outlined goals.
11. Describe any issues that may influence the treatment's length or effectiveness.
12. Indicate the number of therapy sessions required, their frequency, and calculate the total anticipated cost of treatment.
13. Include any additional information that may be beneficial.
14. Ensure both the claimant and the therapist sign the form.
15. Review the completed form for accuracy before submitting.
16. Submit the form to the Victim Compensation Board using the specified address or fax number.

Get started on completing your VictimComp Da18 form online today!