WebCFC Fax Cover Sheet for Insurance Requests – Fax cover sheet for CFCs to use for insurance requests. Assistive Technology Approval Request Form. Insurance Affidavit Form – Child and Family Connections … WebCFC works closely with local early intervention providers and agencies to identify ways to eliminate service gaps. Make a Referral. Anyone can make a referral to the CFC. To …

Early Intervention Service Coordinator Jobs, Employment in

WebSection 5. Early Intervention CFC Office Referral Location Using the attached list of CFC Offices, insert the CFC number where the child is being referred: CFC #: _____ Section … WebEarly Intervention Services include: Audiology; Assistive Technology; Developmental Therapy; Developmental Therapy-Hearing DTH; Developmental Therapy-Vision … fluted chair legs

Early Intervention - Child and Family Connections of Central Illinois

WebStandardized Illinois Early Intervention Referral Form Please complete Sections 1 through 6 of this form to refer a child to Early Intervention (EI) for eligibility determination. … WebJillian Santora Same as CFC 331-481-4221 [email protected] DuPage County including Cook County zip codes: 60103 60106 60126 60172 60527 6 Child & Family Connections Clearbrook 1835 W est Central Road Arlington Heights, IL 60005 . 847-385-5070. 847-385-7260 - Fax . CFC Manager: Jason Tietz 12 40 Sherry Mackey Same as … WebStandardized Illinois Early Intervention Referral Form Please complete Sections 1 through 6 of this form to refer a child to Early Intervention (EI) for eligibility determination. Section 1. Child Contact Information Child Name: If the child is known by another name enter it here: Date of Birth: Child Age: Gender: Male Female Race: Address: green gloss coffee table