ESSC

ESS-C-353-9 ESS Assessment Summary (Rev. 2022-03-09)

This form is for the ESS-C-353-9 Contract Assessment Milestone. EC will use this form to document the assessments performed, and the date and time spent on the assessments. If using an assessment not listed on the form, list it in the Other category. The second page of the form is the Assessment Narrative used to document the summary of the areas identified in the assessments and through observation which require additional training and supports to assist the individual with increased independence, community engagement, and employability.

ESS-C-345 ESS Authorization Request and Billing Form (Rev. 2023-08-09)

The EC will complete and submit the ESS-C-345 Authorization Request and Invoice to request authorization for the milestone(s) before providing services. The EC will complete the Authorization Request portion to request the authorizations and will completed the Invoice portion when invoicing for a completed milestone. The EC will submit the required documentation for payment to the DRS Counselor. BEFORE BEGINNING WORK ON ANY MILESTONE, BE SURE YOU HAVE A COPY OF THE AUTHORIZATION IN YOUR FILE.

ESS-C-353-8 ESS Assessment - Transportation Assessment

ESS-C-349 — ESS Assessment Referral ESS-C-353-1 — ESS Assessment - Cognitive Assessment
ESS-C-353-2 — ESS Assessment - Communication Assessment ESS-C-353-3 — ESS Assessment - Computer Technology Assessment
ESS-C-353-4 — ESS Assessment - Daily Living Assessment ESS-C-353-5 — ESS Assessment - Housing Assessment
ESS-C-353-6 — ESS Assessment - Mobility Assessment
ESS-C-353-7 — ESS Assessment - Work/Training Tolerance Assessment

Pages