Ben Theisen

TrainABA - RBT Parent Verification Form

Use this form in California to verify insurance billable and regional center billable hours for RBT services. See Title 17 (Lanterman Act) for most current billable hours requirement. Use of this tool does not guarantee compliance for your specific company, service code, or vendor requirements. (Note: This document is in beta mode.)

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Title Page

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Upload photo of signed paper billing form (if applicable).
Was today's session completed as scheduled?
Location of services delivered
Session start time
Session end time
Name of client receiving services
Name of parent receiving services
Parent signature (or adult in charge)
RBT signature

Ben Theisen

TrainABA - RBT Parent Verification Form

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.