Below are links to a number of Pennsylvania forms available for download, in both Adobe Acrobat and Microsoft Office formats. You may also continue to order forms directly from Leader by calling your Account Manager or using our Contact page.
| Logs |
Select file format: |
| Direct and Collateral Services Log |
Word |
PDF |
| Nursing Services Log |
Word |
PDF |
| Occupational Therapy Services Log |
Word |
PDF |
| Orientation and Mobility Services Log |
Word |
PDF |
| Personal Care Assistant |
|
|
| Personal Care Assistant Weekly Log |
Word |
PDF |
Instructions |
Word |
PDF |
| Personal Care Assistant Daily Encounter Log |
Word |
PDF |
Instructions |
Word |
PDF |
| Physical Therapy Services Log |
Word |
PDF |
| Professional Services Log for Psychological Assessment |
Word |
PDF |
| Psychological Services Log |
Word |
PDF |
| Social Worker Log |
Word |
PDF |
| Speech, Language, and Hearing Services Log |
Word |
PDF |
| Teacher of the Hearing Impaired Services Log |
Word |
PDF |
| |
| Other Forms |
| ACCESS Funds Request Form (PDE-352) |
Excel |
PDF |
|
| ACCESS Funds Request Form for EI Program (PDE-352M) |
Excel |
PDF |
| Administrative Time Study Cost Data Collection Template |
Excel |
N/A |
| Child Participation Form |
Word |
PDF |
| Direct Services Cost Worksheet |
Word |
PDF |
Instructions |
Word |
PDF |
| Partially Federally Funded Staff |
Word |
PDF |
Instructions |
Word |
PDF |
| Medicaid Transportation Claims Cost Report for IUs |
Word |
PDF |
| Medicaid Transportation Claims Cost Report for Schools and Charter |
Word |
PDF |
Instructions |
Word |
PDF |
Cost Worksheet - Attachment A |
Word |
PDF |
| Special Transportation Student List |
Word |
PDF |
| Student Transportation Log |
Word |
PDF |
Instructions |
Word |
PDF |
| Medical Practitioner Authorization |
Word |
PDF |
National Provider Identification (NPI) |
|
|
Application
|
N/A |
PDF |
| NPI Request Authorization |
N/A |
PDF |
| Parental consent: |
|
|
- SBAP Medical Assistance (MA) Billing Parental Consent Form - English (posted 05/31/2007)
|
Word |
PDF |
- SBAP Medical Assistance (MA) Billing Parental Consent Form - Spanish (updated 11/19/2007)
|
Word |
PDF |
- Understanding Parental Consent and the School-Based ACCESS Program - English (updated 03/04/2008)
|
N/A |
PDF |
- Parental Consent - Frequently Asked Questions
|
Word |
PDF |
|
| Service Provider Update Form |
Word |
PDF |
| Self Audit Form |
Word |
PDF |
Self Audit Instructions |
Word |
PDF |
| Service Description Slip |
Word |
PDF |
| SBAP Service Provider Evaluation Log |
Word |
PDF |
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