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