Follow the steps to complete the application online.

1. Click the ‘Get Form’ button to access the application and open it in your preferred editor.
2. Begin by entering the child's full name in the indicated field, along with their date of birth and today's date. Ensure accuracy to prevent delays.
3. Provide the child's Social Security Number and their home address. If there is a different mailing address, fill that out as well.
4. Indicate the child's immigration status by selecting 'YES' or 'NO' for eligibility under Medicaid. Fill in any necessary details related to the child's primary language and health insurance status.
5. Complete the gender identity information and the child’s insurance plan and policy number, including Medicaid/CIN number if applicable.
6. Answer whether the child is enrolled in Health Home Care Management and provide the date of referral if applicable.
7. Input referral information including the name and title of the referrer, their organization, contact details, and reason for referral.
8. Fill in caregiver information for two caregivers if applicable, including their names, contact details, relationship to the child, and whether they are the legal guardian.
9. Detail the child's legal custody status by selecting the appropriate option from the available choices.
10. Enter current providers including school information, therapist details, and any other relevant service providers.
11. If the child is hospitalized, provide the name of the facility and relevant additional information including mental health diagnosis if known.
12. Complete the preliminary eligibility screening questions to determine if the child has chronic conditions or emotional disturbances.
13. Compile any supporting documentation that may be needed to substantiate conditions or diagnoses.
14. Complete the required consent for release of information section, ensuring it is signed by the parent or legal guardian. Include the witness signature as well.
15. Finally, review all filled information for accuracy. Save changes to the document, and if desired, download, print, or share it as necessary.

Take action now and complete your NY Children's Single Point Of Access Application Part 1 online for timely assistance.