UNIVERSAL PACKET SERVICE ENTRY AUTHORIZATIONS Client Name
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_ Initial when applicable Authorization Explanation Exceptions of By signing below and initialing, the client
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E-mail Address
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https://www.dcf.ks.gov/services/PPS/Documents/FY2025 DataReports/Misc/2025 kdads-universal-packet-fillable-form 3.5.2025 final accessible.pdf
Rehabilitation Services Policy Manual SECTION Administrative Issues SECTION NO. 1-1 PART Organizational Structure PUBLISHED 11/24 Page 1 of 1 Section 1 Administrative Issues Part 1
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https://www.dcf.ks.gov/services/RS/Documents/Policy/Sec_1,Sec_2, Sec_3, Sec_4, Sec_5, Sec_6, Sec_7_withoutlinks.pdf
the use of the TDM Request Form, in addition to communication via phone, in-person or email
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hours that a TDM is needed, the CPS Specialist shall notify the TDM Scheduler via email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_0D.pdf
Introduction The Summary of Prevention and Protection Services (PPS) Policy and Procedure Manual Changes provides a list of policies, forms, and appendices with explanations for the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Summary of Changes/Summary of Changes - 2025.7a.pdf
telehealthrocks.org | TelehealthROCKS@kumc.edu School-Based Community Health Workers Background of Community Health Workers in Schools School-based community health workers help
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https://www.dcf.ks.gov/services/PPS/Documents/SE Resources/SchoolBased_CommunityHealthWorkerCHW.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Referral for QRTP Assessment For Child
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Email Address
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Once this form is complete please email to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5115.pdf
This supplemental summary of change includes substantial changes prompted by Kansas House
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The Summary of Prevention and Protection Services (PPS) Policy and Procedure Manual Changes
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Summary of Changes/Summary of Changes - 2025.7b.pdf
If it is in fact an
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to the Family First Grantee (Provider) (shown in the box below by region), Regional Family First Email Inbox (shown in Section 1), and the Region’s FACTS Email Inbox
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4311_Instr.pdf
☐ African ☐ American Indian/Alaska Native ☐ Asian ☐ Black/African American
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Caregiver Email
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Case Manager Email
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Primary Physician Email
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https://www.dcf.ks.gov/services/PPS/Documents/SE Resources/BI_Program_Referral.pdf
Appendix 0E Department for Children and
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The TDM Scheduler will invite professionals if email address is available
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Phone number/email address
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For scheduling, email the completed form to
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_0E.pdf