Forms, Materials and Resources

Forms:

·         HEA 7112 Attention Parents with Health Insurance/Medicaid

·         HEA 7115 Medical Application

·         HEA 7116 Interim Request for BCMH Services

·         HEA 7183 Release of Information and Consent

·         HEA 4423 Nutritional Support Request

·         JFS 07216 Combined Program Application

·         JFS 073216-S Combined Program Application – Spanish

·         BCMH Information Sheet: Steps to Meet Your Cost Share

·         BCMH Information Sheet: Steps to Meet Your Cost Share - Spanish

Brochures:

·         General BCMH Information

·         General BCMH Information – Spanish

·       Medical Home: A Family-Professional Partnership

·         Notice of Privacy Practices

·         Public Health Nurses Services

·         Emergency Management Be-Prepared Kit

·          Standards of Care and Outcome Measures for Children with Cerebral Palsy

·          Standards of Care and Outcome Measures for Children with Chronic Pulmonary Disease

·          Standards of Care and Outcome Measures for Children with Craniofacial Deformaties

·         Standards for Care and Outcome Measures for Children with Spina Bifida 

Informational Documents:

·         Application general letter

·         Application general letter - Spanish

·         Healthy Start Guidelines

·         Ohio Healthy Start Guidelines - Spanish

·         Physician Care Management

·         Renewal Information

·         Renewal Information – Spanish

Manuals:

·         Handbook for Families of Children with Special Health Care Needs

 Resources:

·         Acronyms

·         Glossary of Terms

·         BCMH Rules (Ohio Administrative Code)

Revised 3/1/2009