Get At Home Program Request For School-aged Extended Therapies - Dcrmt

This guide provides clear and supportive instructions for completing the At Home Program Request For School-aged Extended Therapies - Dcrmt form online. By following these steps, users can ensure that all necessary information is accurately submitted for the advancement of their child's therapy services.

Follow the steps to smoothly complete the request form.

1. Click ‘Get Form’ button to obtain the form. This will allow you to access the document and begin filling it out.
2. In Part 1, enter the child's information: fill in the date of birth in the format yyyy/mm/dd, name, phone number, address, city/town, postal code, and specific diagnosis outlining the type of impairment, its location, and degree of involvement.
3. Proceed to Part 2, where you will indicate the intent of service. Specify the type of service to be provided and, if applicable, the surgery date for post-surgical rehabilitation, noting that there are maximum funding limits for different therapies.
4. In Part 3, select the specific service requested: Occupational Therapy (OT), Physiotherapy (PT), Speech-Language Pathology (SLP), or for chiropractic and massage, refer to Part 4. Enter the start and end dates for the service, making sure they do not exceed six months. Also, calculate the total funding requested based on maximum allowable rates.
5. If chiropractic or massage services are requested, complete Part 4. Ensure a physician's referral is included by providing the physician's name, signature, and date signed in the designated area.
6. In Part 5, detail the intended functional outcomes of the service for the child. Identify which outcomes will involve the use of a therapist assistant, if applicable, and refer to the guidelines for assistance.
7. Move to Part 6 to coordinate OT, PT, or SLP services with the existing school/community therapy plan. List the names and professions of the team members consulted.
8. In Part 7, fill out the therapist's information, ensuring that the name matches the payee on future invoices. Provide the therapist's profession, licensing details, and contact information. Indicate if you have previously provided therapy for this child and if an outcome summary has been submitted.
9. Once all parts of the form are completed, ensure that the document is reviewed for accuracy. After finalizing, you can save the changes, download, print, or share the completed form as needed.

Complete your At Home Program Request For School-aged Extended Therapies - Dcrmt online today for timely service access.