Get Ocfs 3920 Doc 2011-2026

Filling out the Ocfs 3920 Doc is an important step in accessing necessary services. This guide will provide you with detailed instructions to complete the document efficiently and accurately online.

Follow the steps to complete your form successfully.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by entering the child's name in the provided field, ensuring you include the last name, first name, and middle initial.
3. Fill in the child's date of birth using the specified format.
4. Indicate the child's sex by selecting either 'Male' or 'Female' as appropriate.
5. Enter the Medicaid Client Identification Number (CIN) in the designated field.
6. Choose the appropriate B2H Waiver type by checking only one of the following options: B2H Serious Emotional Disturbance (SED) Waiver, B2H Developmental Disabilities (DD) Waiver, or B2H Medically Fragile (MedF) Waiver.
7. Select the referral type by checking either 'Initial Referral' or 'Subsequent Referral' if the child’s name is on the waitlist.
8. Provide the name of the Health Care Integration Agency selected by the child or medical consenter.
9. Fill in the phone number and address of the selected Health Care Integration Agency.
10. Enter the full name of the Health Care Integration Agency staff contact.
11. Complete the section identifying the Local Department of Social Services or Division of Juvenile Justice and Opportunities for Youth, specifying if the child is Medicaid eligible.
12. Include the medical consenter's name, relationship to the child, and address.
13. Provide contact information for the local department, including the contact's name, phone number, title, and address.
14. Finally, review all entered information for accuracy. If everything is correct, save your changes and choose to download, print, or share the form as necessary.

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