An Official Website of the Commonwealth of Kentucky
Office for Children with Special Health Care Needs
The materials and forms listed below are referenced in the Kentucky Administrative Regulations of the Office for Children with Special Health Care Needs.
911 KAR Chapter 11:010 Application to Clinical Programs
OCSHCN-10a, Application for Service Legal Guardian.pdf
OCSHCN-10b, Consent for Care.pdf
OCSHCN-10c, Guaranty of Payment Agreement.pdf
OCSHCN-10d, Coordination of Benefits Agreement.pdf
OCSHCN-10e, Application for Service Young Adult.pdf
OCSHCN-10f, Application for Service Head of Household.pdf
OCSHCN-10g, Medical Eligibility List for Clinical and Case Management Services.pdf
OCSHCN-10h, Medical Expense Worksheet.pdf
Family Participation Scale
1:020 Billing and Fees
OCSHCN-20a, Request for Reconsideration of Discharge.pdf
1:060 Medical Staff
OCSHCN-60a, Application for Active Medical or Dental Staff.pdf
OCSHCN-60b, Application for Active Medical APRN Staff.pdf
OCSHCN-60c, Application for Active Psychology Staff.pdf
OCSHCN-60d, Application for Active Medical Physician Assistant Staff.pdf
OCSHCN-60e, Authorization, Attestation, and Release.pdf
OCSHCN-60f, Anti-Harassment and Discrimination Acknowledgment.pdf
OCSHCN-60g, Peer Reference Letter Medical or Dental.pdf
OCSHCN-60h, Peer Reference Letter Psychologist.pdf
OCSHCN-60i, Renewal Application for Active Medical or Dental Staff.pdf
OCSHCN-60j, Facility Recommendation Letter.pdf
OCSHCN-60k, Request for Reconsideration by Medical Advisory Committee.pdf
1:085 EHDI
"Audiologic Guidelines for the Assessment of Infants and Young Children - AAA 2012.pdf
"CCSHCN E106 Questionnaire.pdf
CCSHCN-E107, Infant Audiological Assessment and Diagnostic Center Program Modification, 2009
Guidelines for the Audiologic Assessment of Children from Birth to 5 Years of Age - ASHA 2004.pdf
JCIH 2007.pdf