1. Maine Department of Health & Human Services Office of Aging & Disability Services Supporting Individual Success For People with Intellectual Disabilities & Autism Department of Health & Human Services Office of Aging & Disability Services 41 Anthony Avenue Augusta, ME 04333 (207) 287-9200 www.maine.gov/dhhs/oads OADS SIS Manager Jennifer Fales, LSW Jennifer.Fales@maine.gov SIS-info.dhhs@maine.gov

2. In this Presentation You will Learn to Complete:… 2 SIS Forms for Case Managers Referral Form Release of Information Form

3. The Referral 3 Pre-Planning Phase Explain Process to Individual and/or Guardian Discuss RespondentsConfirm Understanding Document Conversation in EIS

4. The Referral Form 4 Useful Resources! Identify the Consumer

5. The Referral Form 5 Consumer’s Contact Information Accommodations or Assistive Technology Needs

6. The Referral Form 6 Include ALL Guardians Who is Planning to Participate?

7. The Referral Form 7 Contact Information for Service Providers who can Arrange for Respondents Contact Person May or May Not be the Respondent

8. The Referral Form 8 What will the Interviewer Need to Know? Don’t forget to Attach the DHHS Release of Information! SIS Manager Approval if Less Than Three Years Since Last Assessment

9. The Release of Information 9

10. 10 The Release of Information Parties authorized to Receive Information Identify Consumer

11. 11 The Release of Information Identify What Can Be Released Be Sure to Include SIS Assessment and Related Documentation! Who Will Receive Information?

12. 12 The Release of Information Special Acknowledgement for Email

13. 13 The Release of Information Initial for Sensitive Health Information Don’t Forget Check Boxes!

14. 14 The Release of Information Consumer Rights

15. 15 The Release of Information If Someone Other Than Consumer Signs, Indicate Authority

16. One Last Step 16 Fax: 844-892-2705 Fax: 844-892-2705 Encrypted Email rleonard@ghsinc.com

17. 17 Questions?