Get Treasure Coast Early Steps Program Easter Seals Bfloridab Inc Bb

This guide provides step-by-step instructions to assist users in completing the Treasure Coast Early Steps Program referral form online. By following these directions, users can ensure accurate submission of vital information for eligible children.

Follow the steps to complete the referral form successfully.

1. Click ‘Get Form’ button to obtain the document. This will open the referral form for you to begin filling it out.
2. Fill out the referring physician or agency name along with the contact person's name, phone number, and fax number. Ensure that this information is accurate as it is essential for processing the referral.
3. Enter the birth parent's names in the designated field. Use full names to avoid any confusion regarding identity.
4. Provide the birth mother’s Social Security Number and date of birth. This information is crucial for identification purposes.
5. Complete the child’s name, date of birth, and Social Security Number. These details are required for proper recording and tracking of the referral.
6. Input the child’s Medicaid number, if applicable. This assists in determining eligibility for services offered by the program.
7. Fill in the family’s address and primary language to facilitate easy communication and support.
8. If the child does not live with biological parents, indicate the caregiver/guardian’s name, address, and phone number if different from the family’s address.
9. List any areas of developmental concern that you believe require attention. Be as detailed as possible to enhance the understanding of the child’s needs.
10. Provide the reason for the referral. Include any specific information that may assist the evaluators in assessing the child's requirements.
11. Attach signed consent for the release of information along with any relevant medical or developmental documentation. Ensure all necessary documentation is prepared for submission.
12. Once all fields are completed, review the form for accuracy. After confirming the information is correct, you can choose to save changes, download, print, or share the form as appropriate.

Complete your document online today to ensure timely support for your child's needs.