Downloading a Form to Your Computer
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC application. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
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To provide documentation that the service option selection tool, "It's Your Choice: Deciding How to Manage Your Personal Assistance Services," has been shared with the individual and was used in selecting the service delivery option.
When to Prepare
The case manager or service coordinator presents the overview to all:
- initial applicants;
- individuals or members receiving ongoing services at scheduled reassessments; and
- individuals or members who request information on the SRO.
The case manager or service coordinator informs the individual or member of the right to choose service delivery through the Agency Option, the Consumer Directed Services (CDS) option or the SRO.
Number of Copies
One original and one copy.
The case manager or service coordinator gives the original Form 1581-SRO to the individual or member.
Retain a copy of Form 1581-SRO in the case file.
Individual/Member Name — Enter the individual's or member's name.
Medicaid Number — Enter the individual's or member's Medicaid number.
Signature – Individual/Member/Responsible Party and Date — The individual, member or responsible party signs and dates the form indicating the case manager or service coordinator presented this information. If the responsible party is signing for the individual or member, enter the relationship of the responsible party to the individual or member.
Signature –Case Manager/Service Coordinator and Date — The case manager or service coordinator signs and dates the form verifying the information was presented to the individual.