Inhome Aba Program Intake Packet Page 2
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27Behavior Matters, LLC
Teaching Skills for Success
(253) 686-6958;
Requirements t o B egin I n-‐Home A BA S ervices a re:
1.
Completed I n-‐take P acket
Intake F orm
•
HIPPA S ervice A greement a nd C onsent F orm
•
Patient C onfidentiality C ontact F orm
•
Payment P olicy F orm
•
Request/Authorization t o R elease C onfidential M edical & M ental
•
H ealth R ecords a nd I nformation ( Optional – a s n eeded)
Permission t o V ideotape a nd p hotograph ( Optional)
•
2.
In-‐Take A ssessment w ith B ehavior M atters B CBA o r B CaBA ( 2-‐3 H ours)
3.
If I nsurance i s i nvolved ( TriCare) t hen t heir p re-‐approval i s r equired p rior t o a ny e valuation,
therapy, o r o ther s ervice b eing p rovided.
4.
ABLLS-‐R ™ V B-‐MAPP c ompleted b y B CBA o r B CaBA
5.
Meeting w ith A BA t utor t o r eview t reatment g oals a nd p rogram p lan
6.
Arrangement o f s chedule f or I n-‐Home T herapists
2
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