Saint Francis Ministries

800.423.1342

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Saint Francis Ministries
  • Who We Are
    • Our Story
      • Forward in Hope
    • Leadership Team
    • The Saint Francis Foundation
    • Prayer Request
    • Fostering In Faith
  • What We Do
    • Our Services
    • Adoption
    • Foster Care
    • In-Home Prevention Services
    • Independent Living
    • Residential Programs
    • Behavioral Health
    • Fatherhood FIRE
  • Where We Serve
    • Location Overview
    • Arkansas
    • Kansas
    • Mississippi
    • Nebraska
    • Oklahoma
    • Texas
  • Newsroom
    • Ministry News
    • Hi-Lites
    • Donor Stories
    • Annual Reports
    • Fostering in Faith
    • Foster Family Features
  • Our Blog
  • Community Partnerships
  • Careers
    • Careers
    • Careers at Salina West
  • Contact Us

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Saint Francis Texas Provider Forms

January 2021 · Texas

Click on the links below to download the Saint Francis Texas provider forms you need. If a form is missing, please contact your case manager. If you’d like to see a form added to this list, email morgan.rothenberger@st-francis.org.

Provider Agreements and Addendums (Contracts):

  • ADO Provider Contractor, Dec. 2019

  • CPA Saint Francis Affiliate Provider Agreement Texas SSCC Region 1, Dec. 2019

  • GRO Saint Francis Affiliate Provider Agreement Texas SSCC Region 1 GRO RTC SPECIALITY BASE, Dec. 2019

  • SFCS SIL Provider Services Agreement

  • SFCS Subcontractor Consent Form FY 19

  • SFCS TFC Statement of Work – FINAL

Placement Forms:

  • Education Decision Maker (2085e)

  • Medical Consenter (2085b)

  • Placement Authorization (2085FC)

  • Placement Documentation (1509)

  • Placement Summary (DFPS 2279 – Updated 04/21)

  • Rights of Children – Youth in Foster Care (2530)

Financial Forms:

  • IRS Form W-9

  • SFM Direct Deposit Form

Case Management Forms:

  • Case Planning (Plan of Service) (3300)

  • Examination Form (2403)

  • Incident Report (3005)

  • Service Authorization (2054)

Provider Forms

  • SFCS Residential Discharge Form

SFCS Provider Manual

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785.825.0541 ᛫ 800.423.1342 ᛫ 110 West Otis Avenue ᛫ Salina, KS 67401

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785.825.0541 ᛫ 800.423.1342
110 West Otis Avenue ᛫ Salina, KS 67401

© 2022 Saint Francis Ministries ᛫ Privacy (HIPAA) ᛫ Sitemap ᛫ Terms ᛫ Accreditation ᛫