Overview

This procedure operates the caregiver intake packet: the document set a family receives, reviews, and executes between first contact and the start of services. It covers sending the packet, the consent reviews, verification of the executed set, filing, the per-disclosure authorization, and caregiver designation changes. The procedure ends when the office clears the Behavior Analyst to schedule services; later authorizations and designation changes follow the same steps whenever they arise.

Roles

The office runs the packet: it sends each document set, tracks execution, verifies the executed set, files records, issues the family copy, and clears scheduling.

The Behavior Analyst reviews the clinical consents with the family before signature: the consent for functional behavior assessment, and the Service Agreement's consent to treatment with its elections.

The representative is the learner's parent, legal guardian, or other legally authorized representative. The representative executes every signature and completes every acknowledgment and election in the packet.

The Privacy & Security Officer answers questions about the authorization for use or disclosure and about any privacy element of the packet.

Packet Roster

The packet holds ten documents. Six are received and read; four are executed.

Every document travels on every channel. On the web form channel, each received document confirms receipt on its own form, and the Service Agreement's receipt boxes are filled from those receipts. The Caregiver Handbook also posts on the website.

Channels

HippoSign is the default execution channel. The Company account operates under a business associate agreement, and electronic execution happens only through that account.

The web form channel (Formcan) carries each packet document as its own form. Each received document ends with a receipt block: the learner's name, one receipt checkbox, and the representative's signature. The Service Agreement's receipt boxes arrive filled in, read-only, from the receipts on file for the same representative, with each receipt's date shown beside its box. The consent and financial-responsibility boxes are always the representative's own marks.

The print packet is the fallback. Offer it when a family prefers paper or cannot use an electronic channel. A family may switch channels at any point, and every channel produces an equally valid record.

The office sends the current packet build on any channel. Superseded copies are retired when a new build is published.

Procedure

Step 1: Channel election

At first contact, the office asks which channel the family prefers: HippoSign, the web form, or paper. A family that chooses paper receives print documents at every following step; the steps are otherwise identical.

Step 2: Initial send

The office sends the Notice of Privacy Practices and the Consent for Functional Behavior Assessment. This send happens ahead of the treatment plan, as soon as intake opens.

Step 3: Assessment consent review

The Behavior Analyst reviews the Consent for Functional Behavior Assessment with the family and explains what the planned assessment will involve. The representative signs after the review. The same review and signature precede any later assessment during treatment.

Step 4: Intake send

The office sends the remaining packet: the Caregiver Handbook, the notices, the crisis resource sheet, and the Service Agreement. In the print channel these arrive in one folder. On the web form channel the received documents go first, and the Service Agreement follows once every receipt for the set is on file (see Gates).

Step 5: Agreement review and signature

The Behavior Analyst reviews the consent to treatment and both elections with the family: the telehealth election and the school coordination consent. The representative then completes the Service Agreement: the intake block, both elections, the six acknowledgment boxes, and the signature. On the web form channel the four receipt boxes arrive filled from the receipts on file; the representative marks the consent and financial-responsibility boxes.

Step 6: Verification

The office verifies the executed set: the agreement is signed and dated, all six acknowledgment boxes are checked, and both elections are marked. On the web form channel the office also confirms that each filled receipt box matches a receipt on file signed by the same representative. If anything is missing or does not match, the office returns the set to the family and names each item.

Step 7: Filing and clearance

The office files the executed documents in the learner's record, sends the representative a copy, and clears the Behavior Analyst to schedule services.

Step 8: Authorization, as needed

When information will be shared outside treatment, payment, and health care operations, the office prepares the Authorization for Use or Disclosure, one recipient per form. The office confirms every element on the form is complete before the disclosure is made. Questions route to the Privacy & Security Officer.

Step 9: Designation changes

Caregiver additions and removals after intake come in on the Caregiver Designation Change form (CFM-015), signed by the representative, on any channel. The office verifies the signature and files the form with the Service Agreement in the learner's record. A removal takes effect when the office receives the form.

Gates

Four gates hold regardless of channel or timing.

1. An assessment begins only after the signed Consent for Functional Behavior Assessment is on file.
2. Services are scheduled only after the office verifies the executed Service Agreement set.
3. Information leaves treatment, payment, and health care operations only under a completed authorization on file for that recipient.
4. On the web form channel, the Service Agreement is sent only after every receipt for the set is on file, signed by the representative who will sign the agreement.

Records

Executed documents file in the learner's record. An electronic execution files as the signed PDF with its audit report; a web form execution files as the executed form with its signature certificate; a print execution files as the signed original. Documents executed on the prior electronic platform before 2026-08-26 remain valid executed records and file the same way. The family receives a copy of every executed document, on every channel.

The Service Agreement's initial designations, read with every Caregiver Designation Change form on file, are the current caregiver roster. Each change form files with the agreement it amends.

Competency

A workforce member operates this procedure independently only after demonstrating it to the Executive Director or their designee. Each skill in the table is demonstrated unaided and error-free on two occasions, and at least one occasion uses a case the member has not seen in training.

The Behavior Analyst's consent reviews are clinical competencies verified under the clinical training program, outside this table.