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HCBS Manuals & Forms

General Forms

ADRC Information, Referral and Assistance
PDF, 213.02 KB
ADRC Information Referral Assistance Fillable
DOCX, 30.63 KB
ADRC Notification Form with Provisional Plan of Care
PDF, 276.97 KB
ADRC Options Counseling Fillable
DOCX, 50.96 KB
Authorization for Release of PHI
PDF, 224.71 KB
FAI Complete
PDF, 978.11 KB
FAI Complete Fillable
DOCX, 92.30 KB
FAI LOC Outcome - English
PDF, 94.07 KB
FAI LOC Outcome - Spanish
PDF, 31.94 KB
HCBS BI Attestation Form
PDF, 192.11 KB
IDD Person Centered Support Plan
DOCX, 63.20 KB
Participant Interest Inventory
DOCX, 63.86 KB
Participant Interest Inventory_Spanish
DOCX, 77.66 KB
PD Crisis Exception Physician Statement Form
PDF, 202.74 KB
PD Applicant Crisis Evaluation (PD-ACE) Form
PDF, 229.78 KB

FMS Manuals

FMS Information Memorandum
PDF, 183.80 KB
FMS Manual Questions and Answers
PDF, 384.12 KB
FMS Manual
PDF, 1.61 MB

SED Forms

SED Waiver Brochure - Spanish
PDF, 732.31 KB
SED Waiver Brochure - English
PDF, 763.00 KB
Attachment A Initial Clinical Eligibility Form
PDF, 302.72 KB
Attachment A Initial Clinical Eligibility Form
DOCX, 108.82 KB
Attachment B Request for Exception to Minimum Age Criteria
DOCX, 32.48 KB
Attachment C Initial Request For Exception to Age 18 Criteria
DOCX, 32.50 KB
Attachment D Request for Exception to CBCL Criteria
DOCX, 31.18 KB
Attachment E SED Waiver Annual Evaluation of Level of Care (LOC)
DOCX, 38.45 KB
Attachment F SED Provisional Plan of Care
DOCX, 30.49 KB
HCBS SED Participant Interest Inventory
DOCX, 84.26 KB
SED Eligibility New Process
PDF, 148.66 KB
SED Provisional Plan of Care
DOCX, 17.10 KB

SED Manuals

HCBS SED Manual - January 2022 Edition
PDF, 2.36 MB