Provider Forms
- Agency with Choice Assurance Form
- Form to amend Annual Report
- Summary of Budget Form (Attachment B)
- Expense Report Form (Attachment D)
- One Time Amendment Forms
- Attachment A: Request for Non-annualized One Time Funding (DOCX, 41 KB)
- Attachment B: Supplemental Information for One Time Requests (XLS, 18 KB)
- Attachment C: CLA/CRS Transitional One-Time Invoice (DOC, 62 KB)
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Employment Incentive 1X Guide (PDF, 125 KB)
- DDS Employment Incentive 1X Request(XLSX, 23 KB)
- Notice of Opportunity Form(DOC, 62 KB)
- Provider Agreement (word doc)
- Incident Report Forms
DDS Medication Error Report Form 255M (DOC, KB)DDS Electronic Incident Report Form Instructions(PDF, 78 KB)
- Individual Plan Forms
HS No. 17-1 Attachment A Aquatic Activity Screening FormHS 09-1 Attachment A Attachment A - Minimum Preventative Care Guidelines for Persons with Intellectual/Developmental DisabilitiesReferences
- Individual Progress Review
Individual Progress Review (DOC, 92 KB)
Individual Progress Review Additional Page (DOCX, 37 KB)
Individual Progress Review Directions (PDF, 39 KB)
- Emergency Individual Fact Sheet and Instructions
Emergency Individual Fact SheetEmergency Individual Fact Sheet Instructions (PDF, 47 KB)Emergency Individual Fact Sheet Template (PDF, 36 KB)Emergency Individual Fact Sheet Template (DOC, 54 KB)Emergency Individual Fact Sheet Sample (PDF, 60 KB)Emergency Managment Relocation DocumentsEM relocation site revision 11-13 (DOCX, 24 KB)EM 2013 Relocation Site Summary Form (DOCX, 45 KB)