Forms

Child Medical Evaluation (CME)

• DSS Form 5143 – Consent/Authorization Form ¦ Spanish Version of DSS Form 5143 ¦ Instructions for DSS Form 5143
• CME Medical Report Form
• CMEP Report Guidebook is located on the CMEP Provider Portal
• Checklist for CME Reporting (DMA-1061)
• Case Conference Report Form
• PowerPoint for CMEP FY22: Required Report Form Changes
• DCDEE Consent/Authorization Form for Child Medical Evaluation

Clinical Assessment of Protective Parenting (CAPP)

• CAPP Authorization Request
• Consent/Authorization Form for a Clinical Assessment of Protective Parenting (DSS-5401)