The following are forms and instructions for the Community Choices Waiver (CCW) and the Adult Day Health Care (ADHC) Waiver.
- Adult Day Health Care (ADHC) Waiver Home Delivered Meals Policy (PHE)
- Assistive Devices and Medical Supplies Form
- Assistive Technology (AT) Form
- Assistive Technology (AT) Policy
- Back-Up Staffing Plan
- CCW PAS DSW/Participant Relationships and Living Arrangements Guidance
- CCW Service Logs and Instructions
- Change In Status Screening & Decision Making Tool
- Clinical Assessment Protocols Summary (CAPS)
- Clinical Assessment Protocols Summary (CAPS) Instructions
- Confidentiality Consent for Shared PAS and LT-PCS
- Data Management Contractor Problem Sheet Procedure
- Declining ADHC Waiver Offer
- Declining Current ADHC Waiver Services
- Declining CCW Offer
- Declining Current CCW Services
- e148-W Instructions
- EAA Landlord Permission
- Emergency Plan
- Environmental Accessibility Adaptation Form
- Evacuation Tracking Form
- Flexible Schedule/Budget Worksheet
- Have You Heard? Assistive Technology
- Have You Heard? Medically Tailored Meals/Nutritional Counseling
- Individual Responsibility Agreement Form
- Level of Care/Plan of Care Review Checklist
- Major Medical Event (MME) Flowchart
- Medically Tailored Meals (MTMs) / Nutritional Counseling (NC) Referral Form
- Medically Tailored Meals (MTMs) / Nutritional Counseling (NC) Policy
- Monitored In-Home Caregiving (MIHC) Back-Up Staffing Plan
- Monitored In-Home Caregiving (MIHC) Fact Sheet
- Monitored In-Home Caregiving (MIHC) Services Form
- Nursing Therapy Evaluation Form
- Nursing Therapy Evaluation Referral Form
- Nursing Therapy Evaluation Referral Form Instructions
- Nursing Therapy Payment Authorization Form
- Request for Payment Override Form and Instructions
- Restraints Factsheet
- Rights and Responsibilities for Applicants/Participants for Waivers
- SCD Service Log Codes
- Self-Direction Self-Assessment
- Support Coordination Contact Documentation (Electronic form)
- Support Coordination Contact Documentation (Handwritten form)
- Support Coordination Contact Documentation (SCD) Instructions
- Support Coordination Transfer of Records Form
- Transition Services Form
- Waiver Plan of Care (.pdf)
- Waiver Plan of Care (MS Word)