4. Templates for All DocuSign Forms

Templates for All DocuSign Forms

Purpose: This guide contains instructions and procedures to utilize DocuSign in the EI Colorado Provider Portal and Data System. If users have questions or need assistance, please complete the EI Data System Bug and Suggestions form. It is important to consolidate forms into one envelope when possible. Each sent envelope has a fixed cost.

• Prior Written Notice and Consent for Initial Evaluation/Assessment | Short Name: Consent to Eval: Form is sent to DocuSign Recipient #1. Information is pulled from the scheduled evaluation appointment

• Authorization to Release Information | Short Name: ROI: Sent to SC to complete then sent to DocuSign Recipient #1

• AU Notification | Short Name: AU: Sent DocuSign Recipient #1

• EI Screening Record: Sent to Evaluation Participants then to DocuSign Recipient #1

• Health Insurance Authorization Form | Short Name: HIA: Sent to SC to complete then sent to DocuSign Recipient #1

• Prior Written Notice | Short Name: PWN: Sent to SC to complete then sent to DocuSign Recipient #1

• Declining EI Services | Short Name: Decl C: Sent to SC to complete then sent to DocuSign Recipient #1.

• Insurance Exemption/Declination Form | Short Name: Ins Decl: Sent to SC to complete then sent to DocuSign Recipient #1. Only the Insurance Declination portion of the form is available in DocuSign

• Consent for Extended Part C Option | Short Name: Extended Part C: Sent to DocuSign Recipient #1

• Telehealth Recording Statement | Short Name: Telehealth: Sent to DocuSign Recipient #1

• Individualized Family Service Plan | Short Name: IFSP: Sent to IFSP Participants then sent to DocuSign Recipient #1