Forms

ES = Spanish version available.

Form	Title
1581	Consumer Directed Services Option Overview	ES
1582	Consumer Directed Services Responsibilities	ES
1583	Employee Qualification Requirements	ES
1584	Consumer Participation Choice	ES
1585	Acknowledgement of Responsibility for Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services	ES
1586	Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option	ES
1587	Financial Management Services Agency (FMSA) First Consumer Fax Cover Sheet
1720	Appointment of a Designated Representative	ES
1721	Revocation of Appointment of Designated Representative	ES
1722	Employer's Selection for Electronic Visit Verification Responsibilities	ES
1724	New Employee Packet Cover Sheet
1725	Criminal Conviction History and Registry Checks
1726	Relationship Definitions in Consumer Directed Services Employer's Acknowledgment and Certification
1727	Occupational Exposure to Bloodborne Pathogens
1728	Liability Acknowledgement
1729	Applicant Verification for Employees
1730	Wage and Benefits Plan Employee Compensation
1731	Employee Work Schedule and Assigned Tasks
1732	Management and Training of Service Provider
1732-EMR	Management and Training of Service Provider Addendum
1733	Employer and Employee Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services
1734	Service Provider and Employer Certification of Relationship Status for CDS
1735	Employer and Financial Management Services Agency Service Agreement	ES
1736	Documentation of Employer Orientation by Financial Management Services Agency
1737	Employer and Employee Service Agreement	ES
1739	Service Provider Agreement	ES
1740	Service Backup Plan	ES
1741	Corrective Action Plan	ES
1745	Service Delivery Log with Written Narrative/Written Summary
1747	Acknowledgement of Nursing Requirements
1749	Employer and Entity Service Agreement	ES
2067	Case Information
2101	Authorization for Community Care Services
2124	Supported Home Living/Community Support Transportation Log	ES
3687	Emergency Response Services Contractor Findings of Fiscal Monitoring Monitoring Review
3853	Contract Evaluation Summary
8400	Consumer-Directed Services (CDS) Support Advisor Applicant
8584-CDS	Comprehensive Nursing Assessment and Plan of Care - HCS Program	ES