Common Contracts
1 similar Therapeutic Day Treatment Provider Agreement contracts
ContractTherapeutic Day Treatment Provider Agreement • July 14th, 2022
Completed? REQUIRED COMPONENTS 1 Copy of Current Triennial License for TDT Services from DBHDS 2 General citation history report from DBHDS:□ No more than three citations without CAP□ No citations in past two years without CAP□ Copy of CAP 3 Certification of no health and safety violation in past year – provide report or statement of certification on letterhead or signed statement of certification on company letterhead. 4 List of all staff members and titles with the agency (Updates only if you were an approved provider for 2022-2023 school year.) 5 List of all staff members who will be working in the schools (Updates only if you were an approved provider for 2022-2023 school year.) 6 Names, contact numbers, and qualifications of the individuals serving as supervisors for the unlicensed TDT service providers working in a school 7 Certification/evidence of agency employee background check 8 Restraint Training□ Certification□ Name of Technique 9 Signed Contract
