Crime Victims Compensation Program Initial Response and Assessment: Form II

Crime Victims Compensation Program Initial Response and Assessment: Form II - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Crime Victims Compensation Program Initial Response and Assessment: Form II (A fillable form - 56 KB PDF)
Description

Used by the clinical provider to request authorization to provide more than six sessions. This form must be submitted by the sixth session. (6 pages)

Detail
Form number F800-081-000
Availability
Online only. See document above to download.
Keywords counseling, CVCP, Form II, preauthorization, sessions, treatment
Languages English
Valid dates 10-2013
Contact information Crime Victims Compensation
Web pages Help for Crime Victims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.