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Er and the individual and/or responsible party receiving services prior to the initiation of services. A copy MUST be retained by the provider and a copy sent to the District Office. The provider must also ensure that a General Consent and Authorization form is completed and retained by the provider. PROVIDER INFORMATION PROVIDER’S NAME (Last, First, M.I.) EMPLOYER TAX NO. AHCCCS ID NO. IS THERE ANY SPECIAL TRAINING REQUIRED? Yes No Describe: Med Training Needed Yes No Seizure Managemen.

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Services include: Behavior Management. Behavioral Health Case Management Services (with limitations) Behavioral Health Nursing Services. Emergency Behavioral Health Care. Emergency and Non-Emergency Transportation. Evaluation and Assessment. Individual, Group and Family Therapy and Counseling. Inpatient Hospital Services.

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The Division of Developmental Disabilities (DDD) is a service system administered through the Arizona Department of Economic Security (DES) that supports people who develop severe and/or chronic disabilities that may limit a person's ability to do the tasks related to daily living.

Our Mission. The Division of Developmental Disabilities empowers individuals with developmental disabilities to lead self-directed, healthy and meaningful lives. DDD provides supports and services for eligible Arizonans.

MISSION STATEMENT: DDD assures the opportunity for individuals with developmental disabilities to receive quality services and supports, participate meaningfully in their communities and exercise their right to make choices.

Services Food Assistance. Medical Assistance. Refugee Resettlement. Domestic Violence Support. Sexual Violence Support.

A person age 3 years to 6 years must 1) voluntarily apply, 2) be an Arizona resident, and 3) either have one of the following developmental disabilities: Autism Spectrum Disorder, Cerebral Palsy, Intellectual (Cognitive) Disability, Epilepsy, Down Syndrome OR be at-risk for developing one of these disabilities to ...

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232