PRE-ADMISSION REQUIREMENTS

Here is a list of things we will need.....

 

  1. Current Physical, Dental, and Vision

  2. Current Psychological

  3. A copy of Immunization Records

  4. A copies of School Records and MDT

  5. An  Agreement on Intervention Hours

  6. What is the Funding source (address of who to bill to)

  7. Current Medicaid Card and/or any other Insurance Card

  8. Any history information

  9. Any Medical records

  10. Current Medication Scripts for all medications with refills for at least 2 months

  11. Individuals Middle Name

  12. State Ward Verification - (School letter-must have CPS signature *date must be the date the individual actually comes into services)

  13. Birth Certificate and Social Security Card if available

  14. Current IEP

  15. Any court orders of restraining or protection orders currently in place and any other court orders

  16. Finalized Guardianship papers

  17. Current amount of SSI (if applicable)

  18. Name/address of who is payee

  19. Name/address of who is the responsible party for Room and Board

  20. Information on any outstanding debt(s) owed and to who

 

** ALL of these items will need to be in Envisions possession prior to coming into services. If not, the individual will not be allowed to start services**

 

If your have any questions please contact us.

 

Thanks…….

Tonya Kuchar

Director

Location
Contact

 

407 W. Norfolk Ave.

Norfolk, NE 68701​

 

T: 402-371-1147

F: 402-371-1218

 

tklein@telebeep.com

Office Hours

 

Monday - Friday

7:45am-3:45pm

 

Our office is closed for the following holidays:

 

Memorial Day

Independence Day

Labor Day

Thanksgiving Day

Day After Thanksgiving

Christmas Day

New Years Day

 

 

© 2013 Envisions of Norfolk, Inc.