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How to use or fill out Ancillary Service One-to-One (1:1) Request Form YOUTH with our platform
- Click ‘Get Form’ to open the Ancillary Service One-to-One (1:1) Request Form YOUTH in the editor.
- Begin by filling out the Youth Information section, including the youth's name, Customer ID, and Date of Birth.
- In Section 1, provide a Clinical Justification detailing why this service is necessary. Include specific behaviors of concern and goals for One-to-One support.
- Next, outline the Clinical Plan by describing interventions that will be implemented to address identified behaviors and goals.
- Indicate the Requested number of hours per day (up to eight hours) and specify the duration and times when support will be available.
- Complete your information in the Completed By section, including your email, signature, title, agency, phone number, fax number, and date.
- Proceed to Section 2 for input from the Family Guidance Center Clinical Lead. They will indicate their support for One-to-One services and any plans to decrease hours if necessary.
- Finally, Section 3 must be completed by the CSO Resource Manager who will recommend approval based on provided details.
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See more Ancillary Service One-to-One (1:1) Request Form YOUTH versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2018 | 4.8 Satisfied (226 Votes) |
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