Louisiana State Seal
Department of Health and Hospitals logo
Secretary
Dr. Courtney N. Phillips
Back to LDH
Developmental Disabilities
Louisiana.gov > LDH > Office for Citizens with Developmental Disabilities
  • About Us
  • Leadership
  • Emergency Preparedness
  • For Individuals & Families
  • For Providers
  • Locate Services
  • Services & Programs
  • EarlySteps
  • Critical Incident Reporting
  • Resources
  • OCDD COVID-19 Updates

Children's Choice Waiver

Waiver Documents & Forms

Documents:

  • Environmental Accessibility Adaptation Flow Chart
  • EPSDT Personal Care vs. Home Health Services
  • CC Waiver PCA vs. EPSDT-PCS
  • CC Waiver vs. New Opportunities Waiver
  • Emergency Protocol for Tracking Locations
  • Request for Crisis Designation Flow Chart

 Forms:

  • CC Waiver Comprehensive Plan of Care
  • CC Waiver Plan of Care Instructions
  • CC Waiver Plan of Care Revision Request
  • CC Waiver Plan of Care Revision Request Instructions
  • CC Waiver Request for Family Training
  • CC Waiver Request for Crisis Designation
  • CC Waiver Request for Therapy
  • CC Waiver Environmental Accessibility Adaptation Job Completion Form
  • CC Waiver Request for Non-Crisis/Other Good Cause Designation
  • Recipient's Consent for Authorized Representation (all waivers)
  • Rights and Responsibilities Form (all waivers)

 

 

 

Feedback Accessibility
Privacy Policy | Disclaimer
Mailing Address: Louisiana Department of Health | P. O. Box 629 | Baton Rouge, LA 70821-0629
Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225-342-9500 | FAX: 225-342-5568
Medicaid Customer Service 1-888-342-6207 | Healthy Louisiana 1-855-229-6848
Site by Covalent Logic