Forms

ES = Spanish version available.

FormTitle 
1581Consumer Directed Services Option OverviewES
1582Consumer Directed Services ResponsibilitiesES
1583Employee Qualification RequirementsES
1584Consumer Participation ChoiceES
1585Acknowledgement
of Responsibility for Exemption from Nursing Licensure for Certain
Services Delivered through Consumer Directed Services
ES
1586Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) OptionES
1587Financial Management Services Agency (FMSA) First Consumer Fax Cover Sheet 
1720Appointment of a Designated RepresentativeES
1721Revocation of Appointment of Designated RepresentativeES
1722Employer's Selection for Electronic Visit Verification ResponsibilitiesES
1724New Employee Packet Cover Sheet 
1725Criminal Conviction History and Registry Checks 
1726Relationship Definitions in Consumer Directed Services Employer's Acknowledgment and Certification 
1727Occupational Exposure to Bloodborne Pathogens 
1728Liability Acknowledgement 
1729Applicant Verification for Employees 
1730Wage and Benefits Plan Employee Compensation 
1731Employee Work Schedule and Assigned Tasks 
1732Management and Training of Service Provider 
1732-EMRManagement and Training of Service Provider Addendum 
1733Employer and Employee Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services 
1734Service Provider and Employer Certification of Relationship Status for CDS 
1735Employer and Financial Management Services Agency Service AgreementES
1736Documentation of Employer Orientation by Financial Management Services Agency 
1737Employer and Employee Service AgreementES
1739Service Provider AgreementES
1740Service Backup PlanES
1741Corrective Action PlanES
1745Service Delivery Log with Written Narrative/Written Summary 
1747Acknowledgement of Nursing Requirements 
1749Employer and Entity Service AgreementES
2067Case Information 
2101Authorization for Community Care Services 
2124Supported Home Living/Community Support Transportation LogES
3687Emergency Response Services Contractor Findings of Fiscal Monitoring Monitoring Review 
3853Contract Evaluation Summary 
8400Consumer-Directed Services (CDS) Support Advisor Applicant 
8584-CDSComprehensive Nursing Assessment and Plan of Care - HCS ProgramES