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- Click ‘Get Form’ to open the tice agroparistech document in the editor.
- Begin by indicating whether you or your family member is deaf or hard of hearing. Select 'YES' or 'NO' accordingly.
- If you selected 'YES', fill in the name of the person with a disability and their relationship to the patient. Choose from options like Self, Family member, Friend, or Other.
- In the section for services needed, check all applicable interpreter services required for effective communication during your stay. Options include American Sign Language (ASL), Signed English, Oral Deaf Talk, and more.
- If you need someone else to assist with communication before an interpreter arrives, provide their name and initial that you consent to their help.
- Finally, sign and date the form at the bottom to confirm your requests and understanding.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2008 | 4.9 Satisfied (58 Votes) |
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