Cso1079c 2025

See details

4.8 out of 5

141 votes

The document is a Child Certification Documentation Attachment for the Arizona Department of Child Safety's Adoption Subsidy Program. It requires completion by a child's medical, dental, or behavioral health professional to assess eligibility for the subsidy and document any pre-existing conditions. The form collects information on the child's diagnoses, severity levels, current treatments, and potential risks for disabilities or emotional disturbances.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out cso1079c with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering the child's name in the designated field, ensuring accuracy for identification purposes.
Input the child's date of birth to establish age-related eligibility for the Arizona Adoption Subsidy Program.
For each diagnosis listed, enter the corresponding diagnostic code and severity level on a scale from 1 (mild) to 5 (extremely severe).
Provide current treatment details and prognosis for each diagnosis, ensuring comprehensive information is included.
Indicate whether the child is at risk of developing any disabilities or emotional disturbances by selecting 'YES' or 'NO', and provide an explanation if applicable.
Complete the professional's name, degree, specialty, address, phone number, and signature fields to validate the form.

Start filling out your cso1079c form online for free today!

See more cso1079c versions

We've got more versions of the cso1079c form. Select the right cso1079c version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (141 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I sign my cso1079c without printing?

Electronic signatures are a great alternative to traditional signing, as they save time, effort, and money people spend on printing, scanning, and paper delivery. You can electronically sign your cso1079c using a reliable and powerful online document management tool like DocHub. It complies with main eSignature regulations (ESIGN and UETA), so all documents approved there are legally binding and have the same validity as manually signed ones.

How do you get cso1079c?

You can find the latest and most relevant version of the cso1079c in our DocHub forms collection. Search it by categories or utilize the search field to locate the exact template that fits your situation. You may open this form for editing once you find it.