Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, enter the consumer's name in the designated fields, including their first and last name. Below that, input the Unique Client Identifier (UCI) number.
3. Next, provide the vendor's name as requested. Ensure that all vendor information, including the vendor phone number, is filled out accurately to avoid issues.
4. Specify the services provided by indicating the month and year, along with the location for the services. Include details of the individual providing the services, along with their credential.
5. Document the description of the services provided, ensuring you note the service code, start time, and end time in their respective fields.
6. At the end of the form, ensure to include the signature of the parent or legal guardian, along with the date to authenticate the submission.
7. Once all fields are completed accurately, review the information for any errors. After the review, you can save changes, download a copy, print, or share the filled form as necessary.

Complete your documents online a step closer to securing behavioral services for your child.