THE HSC HEALTH CARE SYSTEM
Health Services for Children with Special Needs, Inc (HSCSN)
Caring. Serving. Empowering.
July 27, 2012
Re: New Request Forms for Neuropsychological and Psychological Testing
Dear HSCSN Provider,
The HSCSN clinical staff has developed a Neuropsychological Testing Request Form and a
Psychological Testing Request Form (enclosed) to improve and expedite referrals, reviews and
authorizations. Effective September 1, 2012, these forms must be submitted for service
requests. It is important that you provide all clinical information requested.
When requests are received for neuropsychological or psychological testing, the Care Manager
will forward (email or fax) the appropriate request form to the provider to complete and return.
We encourage you to keep copies of the uncompleted forms to use for future requests.
Please direct questions or comments regarding the request forms to the Utilization Management
Department at 202-974-4695. Thank you for your cooperation and we look forward to our
continued partnership in serving HSCSN enrollees.
Sincerely,
Cyd P. Campbell, MD, FAAP
Chief Medical Officer
Carolyn R. Haynie, M.D.
Chief Psychiatric Medical Officer
Enclosure: Neuropsychological Testing Request Form
Psychological Testing Request Form
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Health Services for Children with Special Needs, Inc. 1101 Vermont Avenue, NW, Suite 1201, Washington, DC 20005 202-466-8483, www.hscsn-net.org
The HSC Pediatric Center 1731 Bunker Hill Road, NE, Washington, DC 20017 202-832-4400, www.hscpediatriccenter.org
The HSC Foundation 1808 Eye Street, NW, Suite 600, Washington, DC 20006 202-454-1220, www.hscfoundation.org
HSC Home Care, LLC 1731 Bunker Hill Road, NE, Washington, DC 20017 202-635-5756, www.hsc-homecare.org