Rhode Island DHS
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Katie Beckett Application Packet

 

Katie Beckett Application

Parent/Guardian Questionnaire

Bank Account Verification Forms

Third Party Liability (TPL) Reporting Form

Verification of Citizenship/ Alienage Form

Racial/ Ethnic Heritage Form

Physician Evaluation Form

Authorization for Disclosure/ Use of Health Information

Rights and Responsibilities Notice

HIPAA Privacy Notice

Supplement for Citizenship and Identity Verification