Initials
1. Bestview Coversheet
2. Bestview Face sheet
DHS 2828B
Notice of Action
What is FMS, SP, and MP
Fiscal Management Services, Support Planner, Managing party
Name 3 types of IHS
1. IHS w/o Training
2. IHS w/Training
3. IHS w/Fam Training
Name 3 providers/services who needs to sign 6791D
Employment, CRS, Day program, CL,
(Must have name form number and full form name)
DHS 2828B Notice of action.
DHS 6790
RMS Worksheet - CRS, employment, DT&H
DHS 6532
CDCS Community Support Plan
Name at least 4 services that requires to send you a 6790?
Community Residential Services or Family Residential Services
Customized Living Services
Hour Customized Living Services
Day and Employment Services
Adult day (daily) – S5102
Adult day (15 min) – S5100
Day support services (15 min) – T2021 UC
Employment exploration services (15 min) – T2019 U2
Employment development services (15 min) – T2019 U3
Employment support services, group (15 min) – T2019 HQ
Employment support services, individual (15 min) – T2019 U9
Prevocational services (daily) – T2014 UC
Prevocational services (15 min) – T2047
Transportation, day support services
Integrated community supports
How many business days do you have to case note before it is LATE?
3 business days
6
DHS 3427
CADI Screening
For Behavioral exception request renewal. What is needed?
Positive behavioral support plan.
How many months do you authorize HSS
and how many units
6 months
600 units
How many days do you have for intial contact
3 days
What are the two DHS forms you need to send out or provide to clients for Notice of privacy and Notice of rights?
1. 1941
2. 4839E
DHS 3067
DD Screening
Name four sets of requirements for Exception request
2. Behavioral
3. Moving to own home
4. Moving from institution
How much can a CM authorize without going to the committee
Homemaker?
IHS?
Homemaker - 10 hours weekly
IHS - 4 hours daily
When can you submit a Service agreement
ASAP?
Name all of the WCCS forms.
You can name the last two digits of those forms.
17 - notice of privacy
21 - Electronic Data consent
28 - Consent for the release of information
30 - Consent form to release exchange health info
40 - Informed consent
51 - Notice of rights
DHS 6791E
DHS 5181
DHS 3418
DHS MNCH Communication
DHS LTC Communication
DHS MA renewal/MN Care program renewal
DHS 6633
DHS 6633A
DHS 6633B
DHS 6633C
DHS 6633D
DHS 6633 - Budget exception
DHS 6633A - Addendum
DHS 6633B - Enhanced Budget request(PCA complex)
DHS 6633C - Instruction to copmlete exception
DHS 6633D - Shared care
Limit costs of supplies and equipment's
$3909
Explain DAP format case noting.
D:
A:
P:
description
action
Purpose