Individual/guardian shall choose a provider for each service identified on your treatment/care plan. Document providers/agency chosen to the right of each service.
I understand that the choice of providers is my responsibility and right as the parent/guardian. I further understand that I have the right to contact the providers prior to selection so that I may determine the best provider for my child. I also understand that I may at any time choose another provider for this service by notifying my current provider.
The individual/guardian shall initial each service to be provided.