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Insurance Exemption/Declination Form July 2016

If the family has private or public health insurance and the insurance plan cannot be utilized to pay for EI services documented on the child's IFSP, the "Insurance Exemption/Declination Form", Appendix E in the Fiscal Managament and Accountability Procedures, shall be completed, documenting the specific reason insurance is not being accessed. A copy of the form shall be sent to the EI Colorado staff at the CDHS and filed within the child's record for the EI Colorado program.

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