Department for Aging and Disability Services
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Documents
ADRC Information Referral Assistance Fillable
ADRC Information, Referral and Assistance- ADRC Options Counseling Fillable
- Authorization for Release of Protected Health Information
- Authorization for Release of Protected Health Information - Spanish
- Authorization for Release of Protected Health Information w ACM Listed ADA
- FAI Complete
- FAI Complete Fillable
- FAI LOC Outcome - English
- FAI LOC Outcome - Spanish
- FE ACE Form ADA
- FE ACE Form ADA Spanish
- Fillable FE Crisis Exception Physician Statement
- Fillable FE Crisis Exception Physician Statement ADA Spanish
- Fillable PD Crisis Exception Physician Statement
- Fillable PD Crisis Exception Physician Statement - Spanish
- HCBS BI Attestation Form
- IDD Person Centered Support Plan
- Participant Interest Inventory
- Participant Interest Inventory - Spanish
- PD ACE Form
- PD ACE Form ADA Spanish
- PD Applicant Crisis Evaluation - PD ACE Form ES
- Provisional Plan Of Care
- Referral and Acknowledgment Form
- Referral and Acknowledgment Form ADA Spanish
Financial Management Services Manuals
Serious Emotional Disturbance Forms
- Attachment A Initial Clinical Eligibility Form
- Attachment A Initial Clinical Eligibility Form
- Attachment B Request for Exception to Minimum Age Criteria
- Attachment C Initial Request For Exception to Age 18 Criteria
- Attachment D Request for Exception to CBCL Criteria
- Attachment E SED Waiver Annual Evaluation of Level of Care (LOC)
- Attachment F SED Provisional Plan of Care
- HCBS SED Participant Interest Inventory
- SED Eligibility New Process
- SED Provisional Plan of Care
- SED Waiver Brochure - English
- SED Waiver Brochure - Spanish