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DHSChild and Youth Mental Health Service Redesign Demonstration Projects

Part 6 — Acceptance of terms and conditions

Service providers must indicate their understanding and acceptance of each part of this document, including the standard DHS service agreement, by signing in the table below. Where a part of this document is not understood or accepted, service providers must attach a tabulated Statement of Departures with an explanation of why that part is not accepted

If this submission is being made electronically, this page should be faxed or mailed separately.

Acceptance of conditions

Part

Acceptance

Non-acceptance

(attach tabulated Statement of Departures)

Part A: General information for service providers

Part B: Service specifications

Part C: Conditions applying to this submissions process

Part D: Template for submissions

Endorsement

Signature of Authorised Officer for Consortium

Name of Authorised Officer (Print)

Title/Office Held

Date

Page 34 of 34

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