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  • Fvv Acknowledgement Form - Ctdssmap.com

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Electronic Visit Verification (EVV) Fixed Visit Verification (FVV) Device Acknowledgement Form The Department of Social Services has contracted with Sandata Technologies, LLC, to implement the Electronic Visit.

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How to fill out the FVV Acknowledgement Form - Ctdssmap.com online

Filling out the FVV Acknowledgement Form is an essential step in ensuring that you receive the home care services you need. This guide will help you navigate the online process of completing the form accurately and efficiently.

Follow the steps to complete the form online.

  1. Click the ‘Get Form’ button to access the form and open it in your browser.
  2. Review the introductory information provided about the FVV device. This section outlines its purpose and how it will help in providing your home care services.
  3. In the designated area, provide your authorized signature. This confirms your acknowledgment of receiving the Fixed Visit Verification device.
  4. Enter the date when you are filling out the form. This is important for record-keeping purposes.
  5. Print your name clearly in the 'Name (Printed)' section. Make sure it matches the name associated with your care.
  6. If applicable, include your title in the 'Title' section, indicating your role related to the form.
  7. Enter the name of the agency you are associated with in the 'Agency Name' section.
  8. Once all fields are completed, you have the option to save your changes, download the form for personal records, print it, or share it as needed.

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Related content

August 2016 - CT.gov
EVV Caregiver Time Capture Best Practices/FVV Device Order Form. Need assistance?...
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