Effective Date: 
1/2018

Documents

Instructions

Updated: 1/2018

Purpose

To provide information to the individual requesting services or the individual receiving ongoing services on the availability of Support Consultation Services in some programs offering the Consumer Directed Services (CDS) option.

Procedure

When to Prepare

Complete this form after the individual reviews Form 1581 and Form 1582 and elects to participate in CDS. The case manager or service coordinator also presents this form to all individuals receiving ongoing services at scheduled reassessments.

Number of Copies

One original and one copy.

Form Retention

Regain a copy of Form 1586 in the case folder.

Transmittal

After the information is reviewed, the case manager or service coordinator gives the original Form 1586 to the individual.

Detailed Instructions

The case manager or service coordinator reviews with the individual:

  • Support Consultation Services as an optional service in some programs;
  • requirements of a support advisor, services a support advisor may provide; and
  • how Support Consultation Services are budgeted and paid through CDS option.

Individual/Legally Authorized Representative (LAR) – Signature — The individual or LAR signs and dates the form to verify the case manager or service coordinator presented this information.

Relationship of LAR to the Individual Receiving Services — Self-explanatory

Case Manager/Service Coordinator Signature and Date — The case manager or service coordinator signs and dates the form to verify the information was presented to the individual.

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