Department for Aging and Disability Services
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General
ADRC Information Referral Assistance Fillable
ADRC Information, Referral and Assistance- ADRC Notification Form with Provisional Plan of Care
- ADRC Options Counseling Fillable
- Authorization for Release of PHI
- FAI Complete
- FAI Complete Fillable
- FAI LOC Outcome - English
- FAI LOC Outcome - Spanish
- HCBS BI Attestation Form
- IDD Person Centered Support Plan
- Participant Interest Inventory
- Participant Interest Inventory - Spanish
- PD ACE Form
- PD Applicant Crisis Evaluation - PD ACE Form ES
- PD Crisis Exception Physician Statement
- PD Crisis Exception Physician Statement Form ES
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