Statutes, codes, and regulations
Virginia Administrative Code
Title 22 - SOCIAL SERVICESAgency 45 - DEPARTMENT FOR THE BLIND AND VISION IMPAIRED
Chapter 51 - REGULATIONS GOVERNING PROVISION OF SERVICES IN VOCATIONAL REHABILITATION
Form - FORMS (22VAC45-51)

Va. Admin. Code tit. 22, agency 45, ch. 51, form FORMS (22VAC45-51)

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Current through Register Vol. 41, No. 10, December 30, 2024
Form - FORMS (22VAC45-51)

Application for Vocational Rehabilitation Services, DBVI-04-01 (rev. 4/2014)

Consent to Release Confidential Information for Alcohol or Drug Patients, DBVI-70-22 (rev. 10/2015)

Consent to Release Health Information, DBVI-70-23 (rev. 10/2015)

Consent to Release Personal Information, DBVI-70-29 (rev. 10/2015)

Eye Exam Report, DBVI-70-20E (rev. 7/2014)

Financial Determination/Redetermination Statement Form, DBVI-70-06 (rev. 9/2014)

Health Checklist/General Medical Examination, DBVI-70-04 (rev. 6/2014)

Individualized Plan for Employment Form (eff. 12/2015)

Individualized Plan for Employment Planned Services Form (rev. 12/2015)

Service Complaint/Grievance Form, DBVI-70-01 (rev. 9/2013)

Va. Admin. Code tit. 22, agency 45, ch. 51, form FORMS (22VAC45-51)

Derived From, Virginia Register Volume 33, Issue 02, eff. 10/19/2016.

Statutory Authority: § 51.5-66 of the Code of Virginia.