The Ohio Association of County Boards of Developmental Disabilities created the attached form for individuals and families to use when seeking treatment for COVID19 symptoms. People can use this form to assist health care professionals with the care and treatment of patients with intellectual and developmental disabilities in these extreme circumstances.

Download the form as a .pdf file, click here or on the above graphic. OACB_ RCNP_Health_Passport_Hospital_Transfer_Form_PDF

Also included here is recommended language provided as guidance from HHS that rationing or denying accommodations during COVID19 treatment is a violation of civil rights. You can click here to print out legal guidance and give it to the hospital along with the “passport” form. Or add a page to the “passport” form that says something along the lines of:

This information is not a waiver of any civil rights for this patient under federal and state law including but not limited to the Section 1557 of the Affordable Care Act and Section 504 of the Rehabilitation Act which prohibit discrimination on the basis of disability in health programs or activities. For more information see “Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)” from U.S. Department of Health and Human Services at https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf and “Applying HHS’s Guidance for States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing” at  https://www.centerforpublicrep.org/wp-content/uploads/2020/04/Guidance-to-States-Hospitals_FINAL.pdf.”