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INITIAL SERVICE COORDINATION
1
EIP A Parent's Guide_English
2
EIP Referral Form_Spanish_Just Read
Initial (SC) Package
3a
Family Information Form
3b
Family Information Form_Instruction
4a
Insurance Information
4b
Insurance Information_Instruction
5
Parental Consent to Use text messages to Exchange Personally Identifiable Information
6a
Parent Refusal to Provide Insurance Information
6b
Parent Refusal to Provide Insurance Information_Instruction
7
Child information change form
8
Change in Service Coordinator
9
Request for Additional Evaluation
10
NYCHHC HIPAA Authorization to Disclose Health Information
11
Child & Adolescent Health Examination Form
12a
Closure Form
12b
Closure Form_Instruction
13
Parental Consent to Use E-mail to Exchange Personally Identifiable Information
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