Establishes specificobjectives, goal andservices to meet an enrollee's needs.
This is State of Florida form is utilized when someone acts on behalf of the enrollee in determining the enrollee’s eligibility
A level I assessment to identify serious mental illness or intellectual disability.
This is a State of Florida form and it grants permission and authorization of any bank
This form serves as documentation that Participant Directed Option was discussed with all home-based members.
This State of Florida assessment is to be completed initially and annually for new enrollees who reside in home and community-based settings. This form is to be completed when requesting a level of care from DOEA CARES.
This form is completed when a critical event has negatively impacted the health, safety, or welfare of an enrollee.
Written statement detailing a person's desires regarding their medical treatment.
This is form used when the enrollee does not agree with his/her denial letter and wants to file an appeal.
A document that lets you to appoint another person to express wishes and make health care decisi
This State of Florida assessment is to be completed initially and annually for enrollees who reside in a nursing facility.
Establishes the right to choose between HCBS/Non-HCBS services
Details Monthly cost of member’s HCBS services
A form to appoint a guardian for a minor or adult.
This State of Florida form is used to report a change in address, income, and/or assets to the Florida Department of Children and Families.
701B
Freedom of Choice
Unit Calculator
PASRR I
Member Consent for Appeal
Appointed Designated Representative
Possible Quality Issue (PQI)
701T
Guardianship
PDO Consent Acknowledgement Form
Living Will
Healthcare Proxy
DCF 2515 Form
Person Centered Care Plan
Financial Release Form
