You can search for reports, forms, policies and pamphlet and posters with information about specific programs and services.
Download | Number | Name | Effective Date |
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DDD-1985A-S | Personal Identification Information - PIF (Spanish) | 03/01/2019 |
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DDD-1986A | PRC Contact Information (English) | 01/01/2022 |
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DDD-1986A-S | PRC Contact Information (Spanish) | 01/01/2022 |
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DDD-1987A | Team Agreement of Behavior Treatment Plan (English) | 02/01/2024 |
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DDD-1987A-S | Team Agreement of Behavior Treatment Plan (Spanish) | 02/01/2024 |
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DDD-1988A | PRC Disposition (English) | 03/01/2022 |
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DDD-1988A-S | PRC Disposition (Spanish) | 03/01/2022 |
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DDD-1991A | DDD Eligibility Checklist (English) | 10/01/2022 |
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DDD-1991A-S | DDD Eligibility Checklist (Spanish) | 10/01/2022 |
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DDD-2010A | Out-of-Network Claims Submission Guide | 05/01/2019 |
Download | Number | Name | Effective Date |
---|---|---|---|
|
LCR-1025A | Application for Initial HCBS Certification (English) | 09/01/2022 |
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LCR-1025A-S | Application for Initial HCBS Certification (Spanish) | 09/01/2020 |
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LCR-1028A | Agency Roster of Employees | 07/01/2023 |
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LCR-1030A | Request to Withdraw HCBS Certification | 10/01/2020 |
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LCR-1031B | Child or Adult Developmental Home Caregiver Assessment Guide | 12/01/2022 |
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LCR-1031B-S | Hogares de Desarrollo para Menores o Adultos - Guía de Evaluación del Cuidador | 12/01/2022 |
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LCR-1033A | Life-Safety Inspection Request | 02/01/2020 |
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LCR-1034A | Criminal History Self Disclosure Affidavit (English) | 10/01/2019 |
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LCR-1034A-S | Criminal History Self Disclosure Affidavit (Spanish) | 10/01/2019 |
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LCR-1040A | Health Self-Disclosure | 01/01/2018 |
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