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For Assisters

Forms

Consumer Info Sheet

This form is for Assisters to provide to consumers. The form should be completed by the consumer so all their essential DC Health Link information is kept in one place. An Assister should never keep a copy of this form or the information within on file.

Outreach Event Request Form

This form is for Assisters to attain permission from the DC Health Link Communications and Outreach Team to plan and implement additional enrollment events and activities.

Outreach Event Reporting Form

This form should be completed following every outreach event by one person from each present organization.

Consumer Tracking Form

Each Assister is required to track their consumer interactions via this form. This consumer tracking from replaces the consumer tracking form previously found within the ART Tool.

Assister Consent Form: Contact Center (English)

This form is for Assisters to provide to consumers who would like to give permission to the designated Assister to receive updates on their behalf from the DC Health Link Contact Center.

Assister General Consent Form (English)

This form is for Assisters to provide to consumers to sign prior to the Assister assisting the consumer with enrollment. This consent form needs to be completed by the consumer each time they request enrollment help from an in-person Assister.

Assister Consent Form: Contact Center (Spanish)

This form is for Assisters to provide to consumers who would like to give permission to the designated Assister to receive updates on their behalf from the DC Health Link Contact Center.

Assister General Consent Form (Spanish)

This form is for Assisters to provide to consumers to sign prior to the Assister assisting the consumer with enrollment. This consent form needs to be completed by the consumer each time they request enrollment help from an in-person Assister.

Outreach Event After Action Summary Report

This form should be completed by each Assister following every event. The form should summarize what took place at the event and quantify the enrollment effort.

Amharic Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.

Chinese Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.

French Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.

Korean Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.

Spanish Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.

Vietnamese Interpretation Waiver

Assisters must use this form to obtain written consent from a consumer when the consumer waives their right to translation and interpretation services or insists on using a friend or family member as an interpreter.