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Provider Forms and Documents

Competitive Procurement I Evidence Based Practice with Delinquent Youth I Forms
DCS Provider Directory I PD4T Class Schedule (2008-2009) I Provider Policies and Manuals
Provider Policy 30-day Review I Provider Scorecard I PBC Summary I TennCare Help I
TN Kids Applications I Training I Contracting with DCS I Provider Training

0705 Absconder/Runaway/Escapee/Recovery Checklist
0403 Appeal for Fair Hearing
0778 Application for Post Custody Services
0559 Authorization for Release of Child-Specific Information from DCS and Notification of Release
0559 Spanish Version
0206 Authorization for Routine Health Services for Minors
0845 Background Checklist and Results Summary
0427 Child’s Medical Record
0677 Closed Adoption Case Record Face Sheet
0684 Confidentiality Agreement
0910 Confirmation of Review of Runaway Prevention Plan
0741 Database Search Results
0553 Discipline Policy
0830 Dispute Resolution Request
0708 EPSDT Physical Examination
0691 Fingerprint Card Information
0689 Health Services Confirmation and Follow up Notification
0780 Help Desk Ticket Request for Providers
0676 Home Safety Checklist
0761 Interdependent Living Program Review Request
0627 Informed Consent for Psychotropic Medication
0460 Intent to Adopt and Application for Adoption Assistance
0687 Internet Records Clearance
0422 Mail and Acknowledgment of Case Records, Record Materials and Forms
0593 Medication Observation Record
0707 Medical Self-Report (Annual) Resource Parent/Child
0431 Monthly Family Income and Expenditures
0450 Notice of Removal of a Child from a Resource Home
0158 Notification of Equal Access to Programs and Services and Grievance Procedures
0749 Penalty Letter for Harboring
0629 Psychotropic Medication Evaluation
0695 REACT Child Entry Information
0696 REACT Child Status Information
0697 REACT Family Entry Information
0698 REACT Family Status Information
0334 Request for Access to Human Subjects or Records, which may involve Informed Consent
0541 Request for Information
0435 Request for Name and/or Address of Father of Child Born Out of Wedlock
0628 Request for Prior Approval of PRN Psychotropic Medication
0542 Research Involving Study of Existing Records or Data
0675 Resource Family Cover Sheet
0871 Resource Family Disaster Plan
0685 Resource Family Update Checklist
0773 Resource Home Addendum
0692 Resource Home Mutual Reassessment
0544 Resource Home Placement Checklist
0630 Resource Home Prescription Medication Record
0690 Resource Home Study Verifications Checklist
0678 Resource Parent Medical Report
0673 Resource Parent Oath of Confidentiality
0670 Resource Parent Oath to Abide
0672 Shared Resource Home Authorization
0674 Special or Extraordinary Rate Request
BI-0083 TBI Missing/Wanted Person Report
TennCare Medical Appeal
0636 Title VI Complaint
0594 Visitation Observation Checklist
0583 Waiver of Right to Appeal
0779 Web Application Access and Training Request
0543 Well-Being Information and History
0209 Youth Education Training Roster