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Effective Date: 
11/2020

Documents

 

Instructions

Updated 8/2020

 

Purpose

Form 8648 is used to document a person’s preference for Intellectual and Developmental Disability (IDD) services.

When to Prepare

After providing an explanation of IDD services, local intellectual and developmental disability authority (LIDDA) staff will assist the person and the person’s legally authorized representative (LAR) or actively-involved person to identify the types of services preferred. (The term “primary correspondent” used on the form means the person who identified the preferences, which may be the person, LAR or actively-involved person.)

Form 8648 is completed when the person initially presents at the LIDDA for services. The form is also used each time the primary correspondent wants to change preferences.

For services other than Home and Community-based Services (HCS) or Texas Home Living (TxHmL), the service should be identified only if the primary correspondent wants the person to receive the service within the next 30 days.

Form Retention

The LIDDA maintains the hard copy or an electronic copy of the form in the person’s record until the person has enrolled in or received every identified preferred service.

 

Detailed Instructions

Name of Person to Receive Services — Enter the person's name as it appears in the Client Assignment and Registration (CARE) System.

Local Case Number — Enter the person's local case number assigned by the LIDDA.

Indicate the person's preference(s) by selecting at least one of the following — Check each box that corresponds with the primary correspondent’s stated preference.

Date of Discussion (required) — Enter the date the primary correspondent identified the preferred services with the LIDDA staff.

Primary Correspondent Contact Information

Name and Relationship Enter the full name of the primary correspondent and the relationship to the person.

Area Code and Telephone No. (required) — Enter the primary correspondent’s main phone number and select whether it is their cell or home number.

Email Address — Enter the primary correspondent’s email address if they have one.

Alternate Telephone No. (required, if available) — Enter the primary correspondent’s alternate phone number, which may be a residential land line, a work number, or the cell number for a close relative or friend.

Mailing Address (required)  — Enter the primary correspondent’s complete mailing address, including apartment number, if any.

Alternate Correspondent Contact Information

Name and Relationship (required) — Enter the full name of the alternate correspondent and relationship to the person.

Area Code and Telephone No. (required) — Enter the alternate correspondent’s main phone number.

Signature – Primary Correspondent — The primary correspondent signs the completed form. (A signature is required if the primary correspondent is present when the form is being completed or when the primary correspondent checks the box to remove the person’s name from the HCS or TxHmL interest list. If the primary correspondent is not present when the form is completed, the LIDDA must write in “by phone” on the signature line). 

Date Enter the date the form was signed.

Signature – LIDDA Representative (required) — The LIDDA staff who assisted the primary correspondent in completing the form signs the form.

Printed Name and Title - LIDDA Representative (required) — Enter the printed name and title of the LIDDA staff.

Date (required) — Enter the date the LIDDA staff signs the form.