Pw 123 certification need infants toddlers 2026

1. Click ‘Get Form’ to open the pw 123 certification in the editor.
2. Begin by entering the individual's name, parent/legal guardian's name, and current address in the designated fields.
3. Fill in the date of birth and social security number accurately to ensure proper identification.
4. In Section I, select either A or B based on whether the individual meets the ICF/MR/ORC level of care criteria. If they do, complete Section A; if not, proceed with Section B.
5. Provide your signature, date, address, and telephone number in the appropriate fields to certify your assessment.
6. Section II requires input from a County MH/MR Program designee. Ensure they complete their section for final determination.

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