Provider Enrollment Forms
All forms needed for the following First Steps provider types are provided below:
Interpreters |
Occupational Therapists |
Orientation & Mobility Specialist |
Paraprofessional |
Parent Advisor |
Parent Mentor |
Physical Therapist |
Translator |
Service/Intake Coordinator |
Special Instructor/Developmental Therapist |
Speech Pathologist |
Transportation |
Vision Specialist |
All other disciplines (listed below) still need to contact the Central Finance Office at
1-866-711-2573, Ext. 2, for Medicaid forms not provided below.
Audiologist |
Counselor |
Dietitian |
Nurse (RN and LPN) |
Assistive Technology Provider (DME) |
Optometrist |
Physician |
Psychologist |
Social Worker |
*Forms are in pdf format
All Providers |
Providers Offering Transportation Services |
Agencies, or Providers Receiving Direct Payment to Payee Forms |
|---|---|---|
| *Provider Checklist | ||
| *CFO Provider Information | ||
| New! *CFO Service Provider/Payee Agreement (Birth to 3) | ||
| *FBI/Highway Patrol Background Check Procedures | ||
| Scheduling a Fingerprinting Appointment | ||
| Family Care Safety Registry | ||
| *Lobbying, Debarment, Suspension Form | ||
| *Certification for Online Claims | ||
| *Electronic Signature | ||
| *User Online Access Request |