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  • Payer Session Note Signature Requirements

  • Parent/Caregiver Signatures

  • If you selected "4 or more", please provide the information requested below for three of the payers. 

    Please submit information on additional payers to templates@casproviders.org and use the subject line "Payer Session Note Signature Requirements."

  • Payer #1

    Parent/Caregiver Signatures

  • Payer #2

    Parent/Caregiver Signatures

  • Payer #3

    Parent/Caregiver Signatures

  • BCBA or QHP Signature

  • If you selected "4 or more", please provide the information requested below for three of the payers. 

    Please submit information on additional payers to templates@casproviders.org and use the subject line "Payer Session Note Signature Requirements."

  • Payer #1

    BCBA or QHP Signatures

  • Payer #2

    BCBA or QHP Signatures

  • Payer #3

    BCBA or QHP Signatures

  • Other Signatures

  • If you selected "4 or more", please provide the information requested below for three of the payers. 

    Please submit information on additional payers to templates@casproviders.org and use the subject line "Payer Session Note Signature Requirements."

  • Payer #1

    Other Signatures

  • Payer #2

    Other Signatures

  • Payer #3

    Other Signatures

  • Additional Questions

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