Home Billing Form (Word Format)Home Billing Form (PDF Format)
| Service Provider Update Form. Please click on the link below. PDF format. | ||||||||||||||||||||||||
| Special Incident Report. Please click on the link below. SIR in Word 2003 format. SIR in PDF format. | ||||||||||||||||||||||||
EFT-Direct Deposit: Form PDF format Complete form and return to ebilling@vmrc.net with a voided check copy or bank document for verification. | ||||||||||||||||||||||||
BIS Billing Form (PDF Format) BIS Billing Form – Spanish (PDF Format) | ||||||||||||||||||||||||
Home Billing Form.This form is to be used by vendors in the following categories:
Home Billing Form (Word Format) Home Billing Form (PDF Format) | ||||||||||||||||||||||||
Day Care Billing Form.(PDF Format)
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Excessive Mileage Cost Calculator. This form is for vendors using service codes 116, 117, 805 and 862. Service codes are for Early Start Specialized Therapeutic Services and Specialized Therapeutic Services, Infant Development Program, and In-Home Respite Agency services. Excess Mileage Cost Calculator.(PDF Format)
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Interpreter/Translator Service Time Sheet. This form is to be used by vendors in the following categories:
Instructions for completing Time Sheet (Word Format) Interpreter/Translator Service Time Sheet (PDF Format) | ||||||||||||||||||||||||
| Patch Funding Sheet. This form is to be used by Residential, Day Program, and Other Vendors to document their billing for Supplemental Program Support, sometimes referred to as “Patch” Funding, which is supplemental staffing on a time-limited basis for a specific consumer. PATCH Funding Sheet (Excel Format) PATCH Funding Sheet (PDF Format) |