Form 1290, Long Term Care Claim |
Form 1351, Request to Withdraw from the CLASS Application ProcessES |
Form 1581, Consumer Directed Services (CDS) Option OverviewES |
Form 1582, Consumer Directed Services ResponsibilitiesES |
Form 1583, Employee Qualification RequirementsES |
Form 1584, Consumer Participation Choice |
Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES |
Form 1720, Appointment of a Designated RepresentativeES |
Form 1735, Employer and Financial Management Services Agency Service AgreementES |
Form 1739, Service Provider AgreementES |
Form 1740, Service Backup PlanES |
Form 1741, Corrective Action PlanES |
Form 2067, Case Information |
Form 2076, Authorization to Release Medical InformationES |
Form 2432, CLASS and DBMD Children Program Vehicle Evaluation |
Form 3591, CLASS IPC/IDRC Cover Sheet |
Form 3595, IPP Service Review |
Form 3596, PAS/Habilitation Plan – CLASS/DBMD/CFC |
Form 3598, Individual Transportation Plan |
Form 3621, CLASS/CFC — Individual Plan of Care |
Form 3621-T, CLASS/CFC – IPC Service Delivery Transfer Worksheet |
Form 3622, Denial of Application for CLASSES |
Form 3623, Approval of Application for CLASS |
Form 3624, Termination, Reduction or Denial of CLASSES |
Form 3625, CLASS/CFC - Documentation of Services DeliveredES |
Form 3627, Specialized Nursing Certification |
Form 3628, Provider Agency Model Service Backup Plan |
Form 3629, Individual Program Plan Addendum |
Form 3657, Pre-Enrollment Assessment |
Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation |
Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications |
Form 4800-D, Fair Hearing Request Summary |
Form 4800-DA, 4800-D Addendum |
Form 6509, CLASS/DBMD Coordination of Care |
Form 6515, CLASS or DBMD Nursing Assessment |
Form 8001, Medicaid Estate Recovery Program Receipt AcknowledgementES |
Form 8401, Employment First Discovery Tool |
Form 8507, Understanding Program Eligibility - CLASS/DBMDES |
Form 8557, CLASS/DBMD Corrective Action Plan |
Form 8578, Intellectual Disability/Related Condition Assessment |
Form 8598, Non-Waiver Services |
Form 8601, Verification of Freedom of Choice |
Form 8604, Transition Assistance Services (TAS) Assessment and Authorization |
Form 8605, Documentation of Completion of Purchase |
Form 8606, Individual Program Plan (IPP) |
Form 8606-A, Therapy Justifications – Attachment to IPP |
Form 8662, Related Conditions Eligibility Screening Instrument |
Form H1200, Application for Assistance – Your Texas BenefitsES |
Form H1350, Opportunity to Register to Vote |
Form H1746-A, MEPD Referral Cover Sheet |
Form H3034, Disability Determination Socio-Economic ReportES |
Form H3035, Medical Information Release and Disability DeterminationES |