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Outpatient Forms for Great Lakes Center for Autism Treatment and Research

For your convenience, below you can find forms related to the services we have available at the Great Lakes Center for Autism Treatment and Research.

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(33 documents)

Intake Packet
Table of Contents
Welcome Letter
GLC Mission-Vision-Core Values
Location and Hours of Operation
School Year Calendar 2018-2019
what-is-ABA?
What is ABA?
Types of Services Available at GLC
Arrival and Departure
Arrival and Departure
Session Cancellations and No-Show Appointments
severe-weather-procedures
Severe Weather Procedures
For All Sessions at the Center
Client Sick Procedures
Medication Administration Procedures
Medication Administration Procedures
ROI Use of Sun Protection
Patients Rights and Responsibilities
Recipient Rights Notification Form
Confidential Medical Information
Consent for Treatment Form
HIPAA (what you should know about the protection of your privacy)
HIPAA Signature Page
Authorization for Release of Information
Authorization for Release of Information - Natural Environment
Authorization for Drop Off and Pickup and Permission to Observe
Release of Photographs, Audio, and Video Imagery
Financial Policy
ROI Use of Person Restraint in Emergency Situations
Acknowledgment of Receipt of Restraint and Seclusion Policies and Procedures
Permission to Transport
Family Notification Form (Email Request)
Risks of Electronic Communication
Permission for Electronic Transmission (Internet and Text) of Information
GLC Financial Assistance Application

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