CDDO Forms & Other Downloads:                                     

Choose Category BASIS Related Forms Annual Paperwork For CDDO Quality Oversight Paperwork per Completion SRS related forms Crisis Funding CDDO/SRS Collaboration CSP Forms Other Resources CDDO Brochures                                                                         • indicates new or updated document.


BASIS Related Forms

Behavior Tracking Logs  -  for providers to track behaviors for the BASIS assessment   Notice of BASIS Change -  for TCMs to notify CDDO of changes in Information or Services Section   BASIS Questionnaire  -  optional method for gathering input from providers or DSPs

Annual Plan of Care Paperwork (to be Submitted by TCM to the CDDO)

Plan of Care Coversheet (07-11)   MR - 2 (HCBS POC)   Individualized Emergency Backup Plan - for PAS   Statewide Needs Assessment  or   MR - 10 - Supportive Home Care Schedule   Self Directed Guidelines

Needs Assessment Tools:   • Guidelines (updated 4-11-12)           Process        Instructions          Day Care Rates c

Annual Quality Oversight Paperwork (to be Submitted by TCM to the CDDO)

QO Consumer Visit Form  - for Day, Residential, TCM-only, SHC & PAS [How to Complete QO Visits]

Paperwork to be Submitted to CDDO (Per Completion)

CDDO Critical Incident Report   Dispute Resolution Form   Monthly Obligation Form   Third Party Liability • CDDO Provider Choice - Transition Checklist   [See Guidelines for Completing Transition Form]   Case Transfer-Portability Checklist

SRS Related Forms

MR - 1  - HCBS Medicaid waiver Choice form completed initially & filed at CSP   MR - 6 - Consumer directed In-home supports (filed at CSP)   ES - 3160  - Initial notification of HCBS eligibility and services   ES - 3161  - Notice of updates and changes to SRS

Crisis Funding

Crisis Funding Request   Crisis Funding 90 Day Review   Request for Exception to the CDDO Allocation

CDDO / SRS Collaboration Forms

Purpose/Procedures      Authorization for Collaboration   Consumer Needs Identification Form

CSP Forms / Resources

• Completing Background Checks   CSP Internal QO Process   EF Request Coversheet

Other Resources

Extraordinary Funding Materials   HCBS Handbook   HCBS DD Provider Manuals   K-PASS Self-Direction Tool Kit   List of Abbreviations   Parental Fee Program   Procedural Guidelines for Assistive Services   Resources Listing for Douglas/Jefferson County

CDDO Brochures

Transition Planning Guide: Planning from age 5 through High School graduation and into adult services   Choosing Service Providers:  A list of topics to discuss and questions to ask potential service providers   CDDO Brochure: General information about the function of the Cottonwood CDDO