ES = form also available in Spanish.

1581Consumer Directed Services Option OverviewES
1582Consumer Directed Services ResponsibilitiesES
1583Employee Qualification RequirementsES
1584Consumer Participation ChoiceES
1586Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES
1740Service Backup PlanES
2067Case Information 
2124Supported Home Living/Community Support Transportation LogES
3594Individual Plan of Care (IPC) Cover Sheet 
3596PAS/Habilitation Plan - CLASS/DBMD/CFC 
3598Individual Transportation Plan 
3627Specialized Nursing Certification 
3628Provider Agency Model Service Backup Plan 
4800-DFair Hearing Request Summary 
4800-DA4800-D Addendum 
6500Individual Plan of Care (IPC) - DBMD/CFC 
6500-TIPC Service Delivery Transfer Worksheet 
6501Individual Program Plan 
6502Denial of Application for DBMD 
6503DBMD Summary of Services Delivered 
6504Prior Authorization for Dental Services 
6505Daily Census Documentation 
6507Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications 
6508Specifications for Minor Home Modifications 
6509CLASS/DBMD Coordination of Care 
6510Decline of Offer for Deaf Blind with Multiple Disabilities (DBMD) Program Enrollment 
6515CLASS/DBMD Nursing Assessment 
6517Individual Program Plan (IPP) Service Review 
6518Record of Completion for Individual Specific Training 
8001Medicaid Estate Recovery Program Receipt AcknowledgementES
8401Employment First Discovery Tool 
8493Notification Regarding a Death in HCS, TxHmL and DBMD Programs 
8507Understanding Program Eligibility - CLASS/DBMD 
8557CLASS/DBMD Corrective Action Plan 
8578Intellectual Disability/Related Condition Assessment 
8598Non-Waiver Services 
8601Verification of Freedom of ChoiceES
8604Transition Assistance Services (TAS) Assessment and Authorization 
8605Documentation of Completion of Purchase 
8662Related Conditions Eligibility Screening Instrument 
H1200Application for Assistance - Your Texas Benefits 
H1200-EZApplication for Assistance - Aged and Disabled (Large Print) 
H1746-AMEPD Referral Cover Sheet 
H1746-BBatch Cover Sheet 
H1826Case Information ReleaseES
H3034Disability Determination Socio-Economic ReportES
H3035Medical Information Release/Disability DeterminationES