Material Incorporated by Reference

​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 1

1:010 Application to Clinical Programs

• OCSHCN-10a, Application for Service Legal Guardian
  

• OCSHCN-10b, Consent for Care
  

• OCSHCN-10c, Guaranty of Payment Agreement
  

• OCSHCN-10d, Coordination of Benefits Agreement
  

• OCSHCN-10e, Application for Service Young Adult
  

• OCSHCN-10f, Application for Service Head of Household
  

• OCSHCN-10g, Medical Eligibility List for Clinical and Case Management Services
  

• OCSHCN-10h, Medical Expense Worksheet
  

• Family Participation Scale
  

1:020 Billing and Fees 

• OCSHCN-20a, Request for Reconsideration of Discharge
  

1:060 Medical Staff 

• OCSHCN-60a, Application for Active Medical or Dental Staff
  

• OCSHCN-60b, Application for Active Medical APRN Staff
  

• OCSHCN-60c, Application for Active Psychology Staff
  

• OCSHCN-60d, Application for Active Medical Physician Assistant Staff
  

• OCSHCN-60e, Authorization, Attestation, and Release
  

• OCSHCN-60f, Anti-Harassment and Discrimination Acknowledgment
  

• OCSHCN-60g, Peer Reference Letter Medical or Dental
  

• OCSHCN-60h, Peer Reference Letter Psychologist
  

• OCSHCN-60i, Renewal Application for Active Medical or Dental Staff
  

• OCSHCN-60j, Facility Recommendation Letter
  

• OCSHCN-60k, Request for Reconsideration by Medical Advisory Committee
  

1:085 EHDI

• Audiologic Guidelines for the Assessment of Infants and Young Children - AAA 2012
  

• CCSHCN E106 Questionnaire
  

• 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
  

• JCIH 2007