WebThe applicant’s or member’s need for reminding to take medications is documented on Form H2060 or Form H6516 when PAS are authorized. If informal support is reminding an applicant or member to take medications,Form H1700-B, Non-STAR+PLUS HCBS Program Services, should identify the informal support person and the tasks they complete. Task 3. Form H6516 is completed for applicants/individuals being assessed for Community First Choice (CFC) services. The form is used as an instrument for collecting and documenting essential information to determine the functional needs of applicants/individuals age 21 and over for CFC services. See more One Page Profile– The “One-Page Profile” format is based on work by The Learning Community for Person Centered Practices. Insert … See more Current Residence– Check the most appropriate box from the list to indicate where the individual currently resides. Own Home or Apartment 1. Alone – Check this box if the … See more (“Important Because”)– List the people who are close to the individual and who know and care about the individual. This will help the provider in determining who to speak with in certain situations. It will also help to ensure that … See more The Needs Assessment Questionnaire and Task/Hour Guide is comprised of three sections: 1. Part A – Functional Assessment. This part is used to assess an individual’s level of support needs, who currently provides … See more
8100, Home and Community Based Services - Texas
WebMay 23, 2016 · Form H6516, Community First Choice Functional Assessment Form H2060-B, Needs Assessment Addendum Form 1581, Consumer Directed Services Option Overview Form 1582, Consumer Directed Services Responsibilities Take a glance at these forms by selecting the image below: Turn the pages by clicking on the right or left side of … WebSubmit the completed form in duplicate along with the filing fee and certificate of account status. The form may be mailed to P.O. Box 13697, Austin, Texas 78711-3697; faxed to (512) 463-5709; or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. Credit card information must accompany fax transmissions (Form 807). davenport community school district ia
Texas Health and Human Services Office of Inspector General …
WebSep 9, 2024 · contact the person or legally authorized representative (LAR) to schedule a time to meet and complete Form H6516, Community First Choice Assessment. The meeting is conducted face-to-face with the person and LAR. The LAR may attend by telephone if the LAR is unable to attend in person. WebForm 651—General Information (Certificate of Termination of a Domestic Entity) The attached form is designed to meet minimal statutory filing requirements pursuant to the … WebStep 10: Within one business days of receipt of Form H2067-MC with the discharge date information, the gaining PSU staff must: complete the final Form H2065-D and upload to … davenport community center fl