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Effective Date: 
6/2020

Documents

 

Instructions

Updated: 6/2020

 

Purpose

Form 8515 is used by the local intellectual and developmental disability authority (LIDDA) to assist the Service Planning Team’s (SPT’s) discussion regarding whether a person can be adequately and appropriately supported in an available less restrictive setting. This form is intended to outline the person’s or their legally authorized representative’s (LAR’s) preference for a less restrictive setting. The information learned from this form supports the interdisciplinary team (IDT) report required for the state supported living center (SSLC) application submission and court commitment.

 

When to Prepare

Form 8515 is prepared by the LIDDA when admission to an SSLC is considered or requested by the community or a person already enrolled in intellectual and developmental disability (IDD) services. This form should be completed by the service coordinator with the person and their LAR, supported decision maker or other actively involved person, if they have one. If a request for SSLC admission from the community is received for a person not currently receiving services, the intake department completes this form.

 

Transmittal

Form 8515 should accompany any SSLC application from the community or those already enrolled in IDD services.

 

Detailed Instructions

Form 8515 has six sections that should be filled out in entirety:

  • Section 1, Preferences of the Person or Legally Authorized Representative (LAR);
  • Section 2, Preferences for Less Restrictive Setting;
  • Section 3, History of Services and Supports;
  • Section 4, Medical;
  • Section 5, Quality of Life; and
  • Section 6, Persons Under 22 Year of Age Only.

Section 7, Further Explanation for Sections 1 through 6, is used if additional explanation is needed.

Section 16000 of the LIDDA Handbook provides detailed guidance and key items to cover when using this form.