Optar participación en la alerta de EVV para familias: Forma Española

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EVV Alert Opt-In for Families

Please complete the fields below and then click SUBMIT to opt-in for electronic notifications of services provided in our regional center Respite Care program.

These alerts may only be sent to the authorized parent or guardian at their known contact information currently on file with our office. If you wish for both parents to receive alerts, enter one mobile number for one parent to receive a text, and the other parent’s email address.

All alerts are sent out automatically by the EVV system around 10AM and include all completed shifts within 24 hours of that time. Alerts are only generated when service has been logged in the EVV system in live time during that 24 hour period.

Sample of alert wording:
“CISS Auth Update as of (date) at 10:00AM for (UCI#) for 862 Respite: (#) hours provided of (# hours authorized). Balance of (#) hours until the Auth. End Date of (date)”  Please note that “862 Respite” is the service code and description for 1:1 respite care, which is the only type of service that is currently generating alerts. Other service alerts will be added soon.

 

Type of request

New

Updated (changes to info on prior forms submitted)

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First and Last Name of Person(s) Authorized to Receive Services *

If more than one child or adult, please list the full names of both.

UCI Number(s)

Please list the UCI number for each person receiving services listed above. You can find this on regional center documents such as the IPP.

*

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Full Name of Person Completing Form *

Relation to Person(s) Receiving Services *

Parent

Guardian

Other (describe below)

Email Address - Enter Below *

If you do not have an email address, enter JLugo@IslandSocialServices.org and Jocelyn in Family Services will send you the confirmation email with further directions via U.S. Mail.

Mobile Phone for Text Alerts *

Please note: To opt-out in the future you will need to contact our office. By entering a number here, you agree to accept all charges in your mobile phone plan for texting.

Method to Receive Service Alerts *

The system can only send alerts to 1 email address and/or 1 mobile phone by text per authorized individual. Please ensure that the email and mobile phones listed above are the ones you want alerts to be received at. If they are not currently on file in our system, we will contact you by phone to verify.

Text Only

Email Only

Both Text and Email

Captcha *

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Submit