Purpose of the Screening
TMCS Community Care (TMCSCC) offers free Autism Spectrum Disorder (ASD) screenings for children. The goal is to help families learn if their child might need more testing or support for autism or other developmental concerns.
What Will Happen
A nurse or licensed social worker trained in autism screening will meet with you and your child. You will be asked to answer a short list of questions about your child’s behavior and development. The screening takes about 15–30 minutes and uses trusted tools such as M-CHAT-R/F, STAT, or SCQ. The screening is safe and does not involve shots, blood work, or medical tests.
Your Permission
By signing this form, you give TMCSCC permission to:
1. Screen your child for autism using approved tools.
2. Keep your child’s screening results private and secure.
3. Share results only with you and, if you agree, with your child’s doctor or referral partner.
4. Contact you by phone, text, or email about screening results and next steps.
Confidentiality
Your child’s information is private. TMCSCC follows all HIPAA and Florida Department of Health rules to protect your data. We will not share your child’s information without your permission, except as required by law.
What to Expect After the Screening
After your child is screened:
- You will get the results right away or within a few days.
- A TMCSCC team member will explain what the results mean.
- If your child’s results show:
• Low risk – No signs of autism right now. We’ll give you tips for watching your child’s development.
• At risk or positive – Your child may need more testing. TMCSCC will help you schedule follow-up care and connect with resources.
You may also get a follow-up call from a TMCSCC Community Health Worker within 7 days.
Risks and Benefits
There are no medical risks from this screening. You might feel nervous or emotional discussing your child’s development, but our staff will support you and answer your questions. The benefit is early help—finding support early can make a big difference.
Your Rights
This screening is voluntary. You can stop at any time. You will get a copy of your child’s results. Saying no will not affect your child’s ability to get other care or services from TMCSCC.
Parent or Guardian Agreement
I have read this form and understand what the screening is for. I give permission for TMCS Community Care to screen my child for autism and to contact me with results and follow-up information.