Harvey-Marion County CDDO
Harvey-Marion County CDDO
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HMCDDO SERVICE AREA Provider Forms

HMCDDO Webforms

Consumer Status Update

HMCDDO Forms

HMCDDO Request for HCBS IDD Access Form (docx)Download
HMCDDO HCBS Access Request Checklist (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 TCM Monthly Monitoring QA Checklist (docx)Download
HMCDDO TCM Transfer Checklist (docx)Download
HMCDDO Transportation Record Form (docx)Download
HMCDDO Service Initiation & Transition Form (docx)Download
HMCDDO Self-Direction Checklist (docx)Download
CDDO Area Transfer Form (docx)Download
CDDO Notification Form (docx)Download
Consumer Physical Examination Form (docx)Download

HMCDDO Quality Assurance Forms

HMCDDO Behavior Support Plan Guidance (pdf)Download
HMCDDO Behavior Support Plan Review (docx)Download
HMCDDO Psychotropic Medication Plan Review (docx)Download
HMCDDO Quality Indicators (docx)Download

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
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Harvey-Marion County CDDO

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

(316) 283-7997

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