Harvey-Marion County CDDO
Harvey-Marion County CDDO
  • Home
  • About HMCDDO
  • Eligibility
  • Rights
  • Assessment
  • TCM
  • Provider Choices
  • Forms
  • Policies
  • Meetings
  • Community Council
  • AIR
  • Outreach
  • Resources
  • Contact Us
  • More
    • Home
    • About HMCDDO
    • Eligibility
    • Rights
    • Assessment
    • TCM
    • Provider Choices
    • Forms
    • Policies
    • Meetings
    • Community Council
    • AIR
    • Outreach
    • Resources
    • Contact Us
  • Sign In
  • Create Account
  • My Account

  • Signed in as:

  • filler@godaddy.com

  • My Account

  • Sign out

Signed in as:

filler@godaddy.com

  • Home
  • About HMCDDO
  • Eligibility
  • Rights
  • Assessment
  • TCM
  • Provider Choices
  • Forms
  • Policies
  • Meetings
  • Community Council
  • AIR
  • Outreach
  • Resources
  • Contact Us

Account

  • My Account

  • Sign out

  • Sign In
  • My Account

HMCDDO SERVICE AREA Provider Forms

HMCDDO Webforms

Consumer Status Update
Service initiation / transition form

HMCDDO SERVICE ACCESS Forms

HMCDDO HCBS Access Request Checklist (docx)Download
HMCDDO Request for HCBS IDD Access Form (docx)Download
HMCDDO Request for Personal Needs Funding (docx)Download
HMCDDO Discretionary Funding Request (docx)Download
HMCDDO Discretionary Funding Request for TCM (docx)Download

HMCDDO Transfer & Transition Forms

HMCDDO TCM Transfer Checklist (docx)Download
HMCDDO Service Initiation & Transition Form (docx)Download

HMCDDO Quality Assurance Forms

HMCDDO PCSP QA Review Tool (pdf)Download
HMCDDO Quality Indicators (docx)Download
HMCDDO Services Paid & Delivered (docx)Download

HMCDDO MISC. Forms

HMCDDO Self-Direction Checklist (docx)Download
HMCDDO Transportation Record Form (docx)Download
Consumer Physical Examination Form (docx)Download

Licensing Community Service Providers

article 63

HMCDDO Affiliation Process & Forms: HMCDDO

HMCDDO Affiliation Agreement (docx)Download
HMCDDO Affiliation Business Plan Outline (pdf)Download
HMCDDO Affiliation Requirements.Day.Residential (pdf)Download
HMCDDO Affiliation Requirements.FMS (pdf)Download
HMCDDO Affiliation Requirements.Personal Care Services (pdf)Download
HMCDDO Affiliation Requirements.Specialized Medical Care (pdf)Download
HMCDDO Affiliation Requirements.TCM (pdf)Download

HMCDDO Affiliation Process & Forms: KMAP

KMAP.Facility Provider Application (pdf)Download
KMAP.HCBS Provider Application (PDF)Download

HMCDDO Affiliation Process & Licensing Forms: KDADS

KDADS.Workflow New Provider Affiliation (pdf)Download
KDADS.Licensure Packet Instructions (pdf)Download
KDADS.New CSP Suggestions for a Business Plan (pdf)Download
KDADS.IDD CSP Application (pdf)Download
KDADS.Day-Residential Licensing Checklist (pdf)Download
KDADS.Day-Residential License Application (pdf)Download
KDADS.TCM Lisencing Checklist (pdf)Download
KDADS.TCM License Application (pdf)Download
KDADS. Case Manager Rules of Conduct (pdf)Download
KDADS.Limited-License Checklist (pdf)Download
KDADS.Limited-License Application (pdf)Download
KDADS.Licensing Waiver (pdf)Download
  • HMCDDO Staff Login

Harvey-Marion County CDDO

Harvey-Marion County CDDO 500 N. Main Street Suite 204 Newton, KS 67114

(316) 283-7997

Copyright © 2025 Harvey-Marion County CDDO - All Rights Reserved.

Powered by