Facilities Case Mix Forms

A Case Mix Form has been created for each Facility to use for Case Mix submissions.  By clicking on the link below you will find your Facility's Case Mix Form.  Download the Case Mix Form from this website, complete with required information, and submit the Form through the electronic process using your GlobalScape account.

Facility Case Mix Forms

 

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Division of Licensing and Protection
HC 2 South, 280 State Drive
Waterbury, VT 05671-2060
(802) 241-0344

For Telecommunications Relay Service: Dial 711

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(800) 564-1612

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(888) 700-5330

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John Gordon
Adult Protective Services Director

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This is a Division of the
Department of Disabilities, Aging and Independent Living
under the Agency of Human Services