Get Broadscope Respite Form

Filling out the Broadscope Respite Form online is a straightforward process that ensures you receive reimbursement for respite care services. This guide will walk you through each section of the form, providing clear instructions to help you complete it accurately.

Follow the steps to complete the Broadscope Respite Form online

1. Press the 'Get Form' button to access the Broadscope Respite Form and open it in your preferred editor.
2. Begin by entering the print recipient's name in the designated space provided at the top of the form. It is important to ensure the name is spelled correctly.
3. In the date section, fill in the applicable dates for the respite care. Remember to use one line for each date.
4. Indicate the start and end times for each session of respite care, making sure to specify 'AM' or 'PM' accordingly.
5. Record the hours of respite care provided for each listed date. Add the total hours worked at the end of this section.
6. In the rate of pay section, specify the hourly rate you agreed upon for the respite worker’s services.
7. Calculate the total reimbursement amount by multiplying the rate of pay by the total hours worked. Write the result in the designated field.
8. In the respite recipient section, sign and print your name to certify that the services were performed satisfactorily.
9. The respite provider should also sign and print their name, confirming that they provided the services as indicated.
10. As the parent or guardian, you must sign the form as well. Ensure that all signatures are completed before submission.
11. If you require additional forms, indicate your request by selecting 'Yes' or 'No' in the provided checkbox.
12. Finally, submit the completed form by saving any changes, then download or print it as necessary for mailing. Ensure you send it to the Broadscope office promptly for processing.

Start filling out the Broadscope Respite Form online today to ensure timely reimbursement for your respite care services.