l Home Page l What's New l Families l Providers l Contact Us l Links l Find An Office l Employment l Medical Home l Friends of DSCC l
Application Form for Families (Solicitud de Asistencia)
English:
Newborn Hearing Screening: Information
for Parents (form 43.00)
Newborn Hearing Screening: Instructions
for Parents (form 43.01)
Español:
Exámenes Preliminares
De Audición para Recién Nacidos en Illinois: Información
para los Padres (form 43.00S)
Prueba de Audición Universal
para Recién Nacidos en Illinois:Instrucciones Importantes para los
Padres (form 43.01S)
Polski:
Program skriningu sluchu noworodków
w stanie Illinois: Informacje dla rodziców (43.00P)
Program skriningu sluchu noworodków
w stanie Illinois: Wazne instrukcje dla rodziców (43.01P)
The Children's Habilitation Clinic
Coordinated Care Record web page
DSCC & Care Coordination At A Glance (Coordinación de Cuidado en Breve)
DSCC Core Program Brochure (en Español)
DSCC Family Handbook (DSCC Manual para la Familia)
Family Handbook (DSCC) (DSCC Manual para la Familia)
Family Handbook on Future Planning
Family Newsletter: Special Addition
Families Need to Know About a Medical Home
Guidelines for Nurses Working in Home Care (PDF)
Newborn Hearing Screening Program Diagnostic Evaluation Form (form 3.45)
English:
Newborn Hearing Screening: Information for Parents (form 43.00)
Newborn Hearing Screening: Instructions for Parents (form 43.01)Español:
Exámenes Preliminares De Audición para Recién Nacidos en Illinois: Información para los Padres (form 43.00S)
Prueba de Audición Universal para Recién Nacidos en Illinois:Instrucciones Importantes para los Padres (form 43.01S)Polski:
Program skriningu sluchu noworodków w stanie Illinois: Informacje dla rodziców (43.00P)
Program skriningu sluchu noworodków w stanie Illinois: Wazne instrukcje dla rodziców (43.01P)
Home Care Provider Forms:
Illinois Provider Directory for Children with Special Health Care Needs & their Families
Illinois Provider Directory Application form
Information Library for Families
Institute for Parents of Preschool Children Who are Deaf or Hard of Hearing:
Insurance: Questions & Answers About Health Insurance brochure
Links to Resources & Information
Creating a Medical Home: The Foundation for Primary Care Delivery
- Parent Partnerships
- Practice Assessment
- Consumer Awareness
- Practice Improvements
- Preventive Care Management
- Acute Illness Management
- Chronic Condition Management
- Diagnosis Modules
- Transition Information
- Community Resources
- Medical Home Reimbursement
- Quality Improvement
Medical Home CME Monograph for Physicians
Medical Home Brochure for Families
Medical Home Brochure for Providers
Medical Home Services: DSCC Reimbursement Guidelines
Medical Home: What Families Need to Know
Newborn Hearing Screening Program Diagnostic Evaluation Form (form 3.45)
English:
Newborn Hearing Screening: Information for Parents (form 43.00)
Newborn Hearing Screening: Instructions for Parents (form 43.01)Español:
Exámenes Preliminares De Audición para Recién Nacidos en Illinois: Información para los Padres (form 43.00S)
Prueba de Audición Universal para Recién Nacidos en Illinois:Instrucciones Importantes para los Padres (form 43.01S)Polski:
Program skriningu sluchu noworodków w stanie Illinois: Informacje dla rodziców (43.00P)
Program skriningu sluchu noworodków w stanie Illinois: Wazne instrukcje dla rodziców (43.01P)
Privacy Practices Notice (Aviso Sobre Prácticas de Privacidad )
Illinois Provider Directory for Children with Special Health Care Needs & their Families
Illinois Provider Directory Application form
DSCC Provider Approval Criteria
DSCC Reimbursement ProcedureDSCC Provider Application Forms:
- Training and Experience Form
- TIN & Legal Status Certification Form
- Complete and submit only one (1) of the following:
- Liability Insurance Statement
(for Physicians and Health Care Professionals)
- Liability Insurance Statement
(for Health Care Facilities)
- Liability Insurance Statement
(for Therapy Groups)
- Liability Insurance Statement
(for Contractors)
- Liability Insurance Statement
(for Home Care Agencies)
- Liability Insurance Statement
(for Other Health Care Providers)
Newborn Hearing Screening Brochures:
Newborn Hearing Screening Program Diagnostic Evaluation Form (form 3.45)
English:
Newborn Hearing Screening: Information for Parents (form 43.00)
Newborn Hearing Screening: Instructions for Parents (form 43.01)Español:
Exámenes Preliminares De Audición para Recién Nacidos en Illinois: Información para los Padres (form 43.00S)
Prueba de Audición Universal para Recién Nacidos en Illinois:Instrucciones Importantes para los Padres (form 43.01S)Polski:
Program skriningu sluchu noworodków w stanie Illinois: Informacje dla rodziców (43.00P)
Program skriningu sluchu noworodków w stanie Illinois: Wazne instrukcje dla rodziców (43.01P)Core Program Treatment Forms:
- IDPH Newborn Screening Program Diagnostic Evaluation Form (form 3.44)
- Therapy Treatment Plan (form 05.27)
- Pediatric Ophthalmologic Report (form 05.26)
- Physician Recommendation for Hearing Aids (form 05.32)
- Evaluation/Training for Use of Equipment (Vendor Form) (form 05.33-2)
- Evaluation/Training for Use of Equipment (Therapist Form) (form 05.33-3)
Home Care Provider Forms:
- Price Estimate for Medical Equipment & Supplies (PDF)
- Home Care Billing Form (PDF)
- Home Care Billing Form (Word)
Transition Tools for Providers:
School to Work Checklist (De la escuela al trabajo lista de comprobación)
Transition Information Sheet for Families (Información sobre la Transición)
Transition Information & Resources
Transition Milestones Skills Lists For Parents, Caregivers and Others
Transition Milestones Skills Lists Just for Teens
Transition: Bridging the Gap Between Pediatric and Adult Services
Family Handbook on Future Planning
Preparing for the Future: Transition to Adulthood
Work & You: Your Special Health Care Needs in the Workplace
Work Incentives Programs (through the Social Security Administration)
l Home Page l What's New l Families l Providers l Contact Us l Links l Find An Office l Employment l Medical Home l Friends of DSCC l
last modified: 29 March 2013