Get Ny Doh-5153 2016-2026

The NY DOH-5153 form is essential for assessing Medicaid benefits based on a child's disability status. This guide will provide you with a comprehensive, step-by-step approach to successfully completing the form online.

Follow the steps to accurately complete the NY DOH-5153 form.

1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by entering the child's name in the designated fields (Last, First, Middle). This information is crucial for identification purposes.
3. Next, input the case number, date of birth, agency, client ID number, and disability ID number in their respective fields. Ensure accuracy to avoid any delays.
4. Indicate the child's sex by selecting either 'Male' or 'Female.' This helps in further classification and processing of the application.
5. Provide the worker's name and phone number, using the number 1-866-330-0591 if applicable. This connects your application to the right personnel.
6. In the sections regarding the child's abilities, respond to the questions about mobility, social interaction, speech, self-care, play behavior, and any observed behavioral problems. Clearly describe any issues noticed.
7. Complete the section concerning the child's schooling. Fill in the name of the school, the teacher's name, the grade, and any special education requirements or help needed. Provide a description if applicable.
8. Share additional comments regarding school performance, attendance issues, or any other relevant observations that may aid in the disability assessment.
9. Finally, fill out your name, relationship to the child, and your contact telephone number to ensure the form is correctly attributed.
10. Once you have entered all necessary information, review the form for accuracy, then save any changes. You can download, print, or share the form as needed.

Ensure you complete the NY DOH-5153 form online to facilitate the support your child needs.