WesCare Professional Services. A limited liability corporation

Information Needed for Admission

Prior to admission to WesCare programs, consumers must complete enrollment forms and provide the information outlined below. All documents will be held in the strictest confidence, with adherence to HIPAA Privacy and Security rules.

  • Screening/Referral Form
  • Birth Certificate
  • Guardianship/Custody Orders
  • Social Security Card
  • Physicians’ Medical Orders
  • Standing Med Orders
  • List of current medications and signed orders for each
  • Immunization Record
  • Authorization Request submitted to appropriate area authority
  • Discharge Plan (if required for service)
  • Most recent CCA/Psych Evaluation
  • Current PCP/ISP
  • Consents for Release of Information to the other professionals assisting in your care (psychiatrist, therapist, physician, school, LME, etc.)
  • Current contact list of entire team (physician, psychiatrist, therapist, etc.)
  • Authorizations to Disclose Health Info
  • Insurance cards: Medicaid, UnitedHealthCare, MedCo Health Solutions
  • School withdrawal papers (as applicable)
  • IEP (for children only)
  • BIP (for children only