{"id":9511,"date":"2025-03-01T13:55:55","date_gmt":"2025-03-01T18:55:55","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/providers\/"},"modified":"2025-03-02T00:24:43","modified_gmt":"2025-03-02T05:24:43","slug":"providers","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/dpc\/providers\/","title":{"rendered":"dpc\/providers ~  SFL &#8211; Information for Providers  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n  \n\n\n\n\n\n  \n\n\n  <div class=\"container\" id=\"main_header\">\n\n\n    \n\n\n\n\n\n <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/dpc\/providers.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1><!--[type=EDIT name=\"Page Title\"]-->Information for SFL Service Providers<!--[END]--><\/h1>\n\n\n    <\/header>\n\n\n    \n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n\n              <\/div>\n\n\n            <\/div>\n\n\n          <\/div>\n\n\n        <\/div><br>\n\n\n      <\/div>\n\n\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n\n  <!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n\n\n\n\n\n\n<p>Welcome Screening for Life service providers. This section will provide up-to-date information, screening guidelines, policy memos, newsletters, and forms. Visit this site regularly to look for new information and updates.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>SFL Policy Manual <a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl_policymanual_nov2015.pdf\"><img decoding=\"async\" alt=\"Cover of the Screening for Life Policy Manual, available as a PDF file.\" class=\"img-thumbnail img-responsive\" src=\"\/wp-content\/uploads\/sites\/10\/dph\/img\/sfl_policymanual.jpg\"><\/a><\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n <li>PDF Version of the Screening for Life <a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl_policymanual_nov2015.pdf\"><strong><em>Policy Manual<\/em><\/strong><\/a>, revised November 2015 &#8211; <strong>THIS MANUAL IS CURRENTLY BEING UPDATED. PLEASE CONTACT THE SFL PROGRAM IF YOU HAVE QUESTIONS<\/strong>.\u00a0<a href=\"mailto:DHSS_DPH_Healthaccessde@delaware.gov\">DHSS_DPH_Healthaccessde@delaware.gov<\/a> or call 302-744-1040<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Provider Newsletters<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFLHCCDecember2024NewsletterApproved12-23-24.pdf\">December 2024 issue<\/a> [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFLFeb23.pdf\"><span style=\"color: rgb(128, 0, 0);\">February 2023 issue\u00a0<\/span><\/a>[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/september2020.pdf\">September 2020 issue <\/a>[PDF]\u00a0<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl-hcc_newsletter_firstqtr2017.pdf\">First Quarter 2017 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_mar2016.pdf\">March 2016 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_dec2015.pdf\">December 2015 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_sept2015.pdf\">September 2015 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl-chap_newsletter_june2015.pdf\">June 2015 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/fl-chap_newsletter_jan2015.pdf\">January 2015 issue<\/a>\u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_sept2014.pdf\">September 2014 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_may2014.pdf\">May 2014 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl-chap_newsletter_oct2013.pdf\">October 2013 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl-chap_newsletter_mar2013.pdf\">March 2013 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl-chap_newsletter_dec2012.pdf\">December 2012 issue<\/a> \u00a0[PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_jun2011.pdf\">July 2011 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_apr2011.pdf\">April 2011 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_1-2011.pdf\">January 2011 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_9-2010.pdf\">September 2010 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_6-2010.pdf\">June 2010 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sflnewsletter_3-2010.pdf\">March 2010 issue<\/a> \u00a0 [PDF]<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Provider Forms and Applications<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n <li>\u00a0<strong><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl_newprovider_enroll_instructions.pdf\">Instructions for Completing Provider Enrollment Forms<\/a><\/strong> \u00a0 [PDF]\u00a0 <span style=\"font-size: 11px;\"><strong><em>Revised January 2019<\/em><\/strong><\/span><\/li>\n\n\n\n\n\n <li>\u00a0<strong><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/doc\/1-SFLProviderApplication08.24.21.doc\">SFL New Provider Application Form<\/a><\/strong> [PDF]\u00a0 <strong style=\"font-size: 11px;\"><em>Revised March 2024<\/em><\/strong><\/li>\n\n\n\n\n\n <li>\u00a0<strong><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/doc\/2-SFLProviderEnrollmentAgreement03.12.21.docx\">SFL Provider Enrollment Agreement<\/a><\/strong> [PDF]\u00a0\u00a0<strong style=\"font-size: 11px;\"><em>Revised March 2024<\/em><\/strong><\/li>\n\n\n\n\n\n <li>\u00a0<strong><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/sfl_providerenroll_agreement_lungadd.pdf\">SFL Provider Enrollment Agreement for Lung Cancer Screening Providers<\/a><\/strong><\/li>\n\n\n\n\n\n <li>\u00a0<a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2025_SFL_CPT_Codes-01.29.25.pdf\"><strong>2025 Screening For Life Allowable CPT Codes and Rates<\/strong><\/a><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2022-SFL-CPT-Rates.pdf\" target=\"_blank\">\u00a0\u00a0<\/a>[PDF]\u00a0 <span style=\"font-size: 11px;\"><strong><em>Updated January 2025<\/em><\/strong><\/span><\/li>\n\n\n\n\n\n <li>\u00a0<a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFLProvidersList10.15.24.pdf\"><strong>SFL List of Providers<\/strong><\/a>\u00a0 [PDF]<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Client Enrollment Forms<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<p>Send completed enrollment form to:<br>\n\n\n\n\n\nScreening for Life<br>\n\n\n\n\n\n540 S. DuPont Highway, Ste. 11<br>\n\n\n\n\n\nDover, DE 19901<br>\n\n\n\n\n\nor <a href=\"mailto:DHSS_DPH_Healthaccessde@delaware.gov?subject=Completed%20SFL-HCC%20enrollment%20form\">email the form to the Screening for Life program<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2 class=\"phone_contact\">Screening for Life\/Health Care Connection<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><span class=\"dhss-red\"><strong>Client Enrollment Form<\/strong><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL_HCC_Application_English-oct24.pdf\">English<\/a>\u00a0[ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL_HCC_Application_Spanish-oct24.pdf\">Spanish<\/a>\u00a0[ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL_HCC_Application_Haitian_Creole-oct24.pdf\">Haitian (Creole)<\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong><span style=\"font-size: 16px;\">Applicant Self-Attestation Form<\/span><\/strong><span style=\"font-size: 16px;\">\u200b<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCApplicantSelf-AttestationForm.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCApplicantSelf-AttestationForm-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCApplicantSelf-AttestationForm-ht-HA.pdf\">Haitian <\/a><span style=\"font-size: 16px;\"><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCApplicantSelf-AttestationForm-ht-HA.pdf\">(Creole)<\/a>\u00a0<\/span>[ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Delaware Residency Verification Form<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCDelawareResidencyVerificationForm.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCDelawareResidencyVerificationForm-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCDelawareResidencyVerificationForm-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Employment Verification Form ( Applicant )<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-APPLICANT.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-APPLICANT-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-APPLICANT-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Employment Verification Form ( Spouse \/ Parent Guardian )<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-SPOUSE-PARENT-GUARDIAN.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-SPOUSE-PARENT-GUARDIAN-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCEmploymentVerificationForm-SPOUSE-PARENT-GUARDIAN-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Financial Support Verification Form<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCFinancialSupportVerificationForm.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCFinancialSupportVerificationForm-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/2024SFL-HCCFinancialSupportVerificationForm-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Eligibility and Acceptable Information<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL-HCCEligibilityandAcceptableDocs.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL-HCCEligibilityandAcceptableDocs-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/SFL-HCCEligibilityandAcceptableDocs-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n <li>\n\n\n\n\n\n <p class=\"phone_contact\"><strong>Information Sheet ( What is SFL \/ HCC? )<\/strong>\u00a0<\/p>\n\n\n\n\n\n\n\n\n\n\n\n <ul>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/WhatIsSFL-HCCInfoSheet.pdf\">English<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/WhatIsSFL-HCCInfoSheet-ES.pdf\">Spanish<\/a> [ PDF ]<\/li>\n\n\n\n\n\n  <li><a href=\"\/wp-content\/uploads\/sites\/10\/dph\/pdf\/WhatIsSFL-HCCInfoSheet-ht-HA.pdf\">Haitian\u00a0<span style=\"font-size: 16px;\">(Creole)<\/span><\/a> [ PDF ]<\/li>\n\n\n\n\n\n <\/ul>\n\n\n\n\n\n <\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<p><strong>Please Note:<\/strong> \u00a0These forms require legal size (8.5&#8243; x 11&#8243;) paper.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p><span style=\"font-size: 12px;\"><strong><a href=\"sfl.html\">Return to Screening for Life home page.<\/a><\/strong><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>\u00a0<\/p>\n\n\n\n\n\n  <!--[END]-->\n\n\n  \n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Information for SFL Service Providers Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections Screening and Testing WIC Additional [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9401,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-9511","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9511","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=9511"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9511\/revisions"}],"predecessor-version":[{"id":10750,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9511\/revisions\/10750"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9401"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=9511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}