HUGS Participant Forms
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HUGS Participant Forms
May 9th, 2018
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All Program Participants are asked to return all of the applicable forms (below) to “Attention: HUGS” via fax at 239-330-7163.
CONSENT FORMS – REQUIRED
SCREENING TOOLS
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ASQ Social & Emotional Screening for children 3 Months to 6 years- (*THESE WILL COME DIRECTLY TO HUGS FROM THE BELOW LINK) Please click here
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SDQ (Strengths & Difficulties) Questionnaire for children 6 to 18 years. (THESE WILL NOT BE AUTOMATICALLY DELIVERED TO HUGS AND MUST BE PRINTED AND SENT TO HUGS or CALL TO REQUEST THE FORMS) Digital-SDQFormEnglish Please click here
AUTHORIZATION
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Release form (for release of information) This may be completed for a Doctor or other service provider but IS NOT MANDATORY. Digital Authorization to Release Information English.doc2019 (dragged)Authorization to Release Information
Por favor, devuelva todas las formas abajo, por fax al 239-330-7163 – “Atención: HUGS”
FORMA DE CONSENTIMIENTO
CUESTIONARIO DE ASQ (SOCIAL EMOCIONAL)
CUESTIONARIO DE SDQ (FUERZAS Y DIFICULTADES)
Forma de Autorización Para Usar o Divulgar la Información Protegida de SalúdDigital Authorization to Release Information Spanish