Get Fl Dcps Informed Consent And Agreement To Participate In School-based Behavioral Health Services 2020-2025

This guide provides clear instructions on how to fill out the FL DCPS Informed Consent and Agreement to Participate in School-Based Behavioral Health Services form online. By following these steps, you will ensure that the consent process is completed accurately and efficiently.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the student's name in the designated field. Make sure to include the full legal name as it appears on their identification documents.
3. Fill in the student number in the appropriate section, ensuring accurate information to facilitate school records.
4. Select the school the student attends from the dropdown list provided, confirming it aligns with school enrollment.
5. Input the date of birth in the specified format, which helps to verify the student's age and eligibility for services.
6. If requested, provide the student's social security number where indicated, understanding its use for identification purposes.
7. Indicate your relationship to the student by selecting or writing in the appropriate title next to the initial consent statement.
8. Initial where required to indicate your understanding and agreement with the consent statements regarding behavioral health services.
9. Review the descriptions of the provided services and initial next to the understanding of service duration and revocation rights.
10. Acknowledge the confidentiality clause by carefully reading and initialing to confirm your understanding of privacy protections.
11. Grant permission for data access as required, and initial to confirm you understand this data will remain confidential.
12. Complete any necessary information about Medicaid if applicable, including the number and type, then initial accordingly.
13. Sign the form using a digital signature option that may be available or type your name in the required field.
14. Indicate the relationship to the student again and date your signature to ensure the document is completed properly.
15. To finalize your submission, use the options to save changes, download, print, or share the completed form as needed.

Ensure that your form is filled out completely and accurately online to facilitate your participation in school-based behavioral health services.