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Virginia Administrative Code
Title 22. Social Services
Agency 45. Department For The Blind And Vision Impaired
Chapter 51. Regulations Governing Provision of Services in Vocational Rehabilitation
11/21/2024

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)

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