15.3 Documentation of Receipt

When the equipment is delivered, providers must complete the “CSHCN Services Program Documentation of Receipt” form on page B‑114 or the “CSHCN Services Program Documentation of Receipt (Spanish)” form on page B‑115. The date of delivery on the form is the date of service that should appear on the claim. The provider must request a signature from the client or client’s representative at the time of delivery. The provider should retain this form and not submit it with the claim.

Providers must maintain a copy of this form in their files for the life of the piece of equipment or until the equipment is authorized for replacement.