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.
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
OCSHCN-20a, Request for Reconsideration of Discharge
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
OCSHCN E106 Questionnaire
E-107 Audiological Center Modification 2022
Guidelines for the Audiologic Assessment of Children from Birth to 5 Years of Age - ASHA 2004
JCIH 2019