[Name of Respite Supervisor]
After-School Respite Supervisor
Phone:
123-456-7890
Email:
Address:
9317 Avenue L, Brooklyn New York 11236
About After-School Respite Services
Designed for those individuals living at home that would benefit from specialized training, our focus is on the enhancement of daily living activities, independent living skills, communication, socialization, and community awareness skills.
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What’s the end goal? It’s to give individuals the skills necessary to live a comfortable and productive life, being active in their community.
General Registration Process
Step 1- Fill Out Referral Form
Step 2- Schedule a Tour of our program
Step 3- Fill out In-Take Application
Step 4- Submit proof of identification and insurance
Step 5- Care Managers must provide Documents
Download Referral form here
Contact us at 347-502-2956 to schedule a tour of our facility
Please fill out all In-Take Application Forms here
Submit Medicaid, Birth Certificate, Medical
(Encryption needed as per HIPPA laws)
Care Managers must submit:
-Psychological and Psychosocial Evaluations
-Level of Care
-Life Plan
-Notice of Decision
-Service Authorization
-DDP2