Documents

To begin the College Experience Program, the following list of documents must be submitted to Living Resources by August. A packet of materials will be given to each new student for completion.

Medical Documents

• Consumer Profile Sheet

• The College of Saint Rose Immunization Record form

• The College of Saint Rose Medical History form

• Annual Physical Examination form (completed by physician)

• Immunization Records - stamped and signed by your doctor

• PPD test (completed within the last year) and documentation

• Standing Orders form (signed by doctor)

• Doctor's prescription for each medication individual is currently or may be taking

  • This includes all prescription drugs and over the counter drugs (including any medication listed on the Standing Order form)

  • All medications must have a label on the bottle that matches the prescription.

• List of all current physicians (if not currently listed in your ISP)

• All scheduled upcoming medical appointments

• Emergency Contact form (send document)

Financial Documents

• Finance Summary Sheet

• Consumer Finance Profile Sheet

• Room & Board/Representative Payee Status

• Physician's Statement of Patient's Capability to Manage Benefits

• Advance Notification of Representative Payment
  **To be completed only if you are choosing Living Resources as your representative payee

• Notice of Liability letter (parent signature and date)

• Liability Notice (list name and date; do not fill in fee)

• Explanation of Liability Notice (keep for your files)

Financial Documents (a copy of these documents)

• Social Security Card

• Birth Certificate

• Medicaid Card and/or Medicare Card

• Other Health Insurance Card

• Guardianship Papers if applicable

Other Documents from Medicaid Service Coordinator

• DDP-4

• Copy of HCBS Waiver Application

• Copy of NYS non-driver's ID