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Providing services to children with special needs
and their families for over 25 years.

In partnership with Autism Care Partners,
providing quality private insurance services.

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Provider Form Category: Service Coordination

Suffolk

Service Coordinator / Suffolk
  • Collection of insurance information
  • Confirmation of Services
  • CPSE Classification Form
  • E-mail Consent Form
  • IFSP Attendance and Service Agreement
  • IFSP review request
  • Inperson Consent and Guidance
  • Meeting Results
  • Parent Rights
  • RX for Doctor
  • RX for Parent
  • Schedule of Services
  • Transition Forms
  • Transportation Forms
  • Teletherapy Consent Form

NYC

Service Coordinator / NYC
  • RX for Doctor

Nassau

Service Coordinator / Nassau
  • E-mail Consent Form
  • Collection of insurance information
  • Meeting Results Form
  • RX for Doctor
  • RX for Parent
  • Transition Forms
  • 5400 confirmation of services
  • IFSP Amendment Form
  • IFSP consent form
  • MKSA Template for IFSP meetings
  • Nassau Make up policy
  • Parent Rights
  • Teletherapy Consent Form
  • Inperson Consent and Guidance

Contact Us

info@mksa.com

516-731-5588

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