DDP Forms
All Waivers - IGS/MODS/Equip
- Environmental Modifications/Adaptive Equipment/Specialized Medical Equipment and Supplies Guide -To be used with the 0371 Community Supports waiver (Word)
- Individual Goods and Services Guide - To be used with the 0208 children's waiver services and 0667 Children's Autism Waiver (Word)
- Individual Goods and Services Guide - To be used with the 0208 comprehensive waiver and 0371 Community Supports Waiver (Word)
- Environmental Modifications/Adaptive Equipment Guide - To be used with the 0208 comprehensive waiver and 0667 Children's Autism Waiver (Word)
Adult Services - Referral
- Adult Referral File Checklist - 3/18/10
- Annual Referral Update Form - 01/22/10
- Behavior Information Form - 02/10/10
- Community Supports Annual Risk/Needs Planning Assessment - 05/07/09
- Estimated Individual Cost Plan - 02/11/10
- Individual Behavior Assessment (IBA) - 02/16/10
- Medical Group Home Clinical Criteria - Screening Criteria - 05/18/11
- Medical Group Home Clinical Criteria - Scoring Excel Worksheet revised 5/18/11
- Priority Rating Score Sheet - 12/27/11
- Screening Notification Options - 01/06/10
- Skills Assessment - 02/09/10
- Social History - 02/10/10
- Wait List Change Form - (Word) 02/16/12
- Wait List Change Form Instructions - 02/16/12
- Waiver 5 Adult Services Freedom of Choice and Consent Form - 08/01/11
- Waiver 5 Freedom of Choice Addendum - 08/01/11
Application for Title X Funding
- Application for Title XX Funding - 06/09/11 (word document)
- Application for Title XX Funding - 06/09/11 (pdf document)
- Directions for Title XX Funding - 06/09/11
Children’s Autism Waiver (CAW) Documents
- CAW Guide 07/01/11
- CAW application 07/28/11
- CAW Acceptance Form 08/01/11
- CAW Provider Map 03/26/12
- Waiver 5 CAW Services Freedom of Choice and Consent Form - 12/18/09
- Waiver 5 Freedom of Choice Addendum - 08/01/11
Children’s Autism Waiver (CAW) Data Collection
- CAW Data Collection System 04/20/12
- CAW Entry Letter 03/16/12
- CAW Exit Letter 03/16/12
- CAW Evidence-Based Practices Checklist 04/01/12
- CAW Progress Summary Update form 05/11/12
- CAW Pre-CAW Services form 04/01/12
Children’s 0208 Waiver Services (CWS) Documents
- CWS Application Packet 07/19/12 (PDF format)
- CWS Application Packet 07/19/12 (Word format)
- CWS Application Checklist 07/26/11
- CWS Packet - Out of Home Placement 04/13/10
- CWS Resource Checklist 05/04/10
- Waiver 5 0208 Services Freedom of Choice and Consent Form - 12/18/09
- Waiver 5 Freedom of Choice Addendum - 08/01/11
Personal Support Plans (PSP)
- PSP (word) PSP (pdf)
- PSP Amendment (word) PSP Amendment (pdf)
- PSP Consumer Survey (word) PSP Consumer Survey (pdf)
- PSP Healthcare Checklist (word) PSP Healthcare Checklist (pdf)
- PSP Procedure Manual Final
