Section VI: Identified Services, Needs, and Supports Confidential Identified services and supports that will help me maintain and/or achieve my personal outcomes. Medicaid Funded Services Non-Waiver Support NOW Waiver NOW Individual/Family Support (IFS) Supported Employment Dental OCDD Day (D) Transportation REG Eye Glasses – Night (N) Transportation W/C Home Health Extended – Shared Supports Prevocational Services Hospice LRS IFS D Day Habilitation Medical Transportation – IFS N Mental Health – Day Hab/ Transportation Skilled Nursing Podiatry Services CID Transportation REG Substance – Substitute Family Care Transportation W/C Prescriptions/Medication DSS – Center-Based Respite Adult Companion Care Others Professional Consultation Professional Services Transition Professional Support Skilled Nursing Services Environmental Accessibility Adaptations Specialized Medical Equipment and Supplies Personal Emergency Response System (PERS) Community Integration Development (CID) Supported Independent Living (SIL) Natural Supports One-Time Transitional Expenses Community Supports NOTE: Informed individual of all state plan services. Support Coordinator Initials: ___________
Section VI: Identified Services, Needs, and Supports Confidential Identified services and supports that will help me maintain and/or achieve my personal outcomes. NOW Waiver NOW Medicaid Funded Services Non-Waiver Support Individual/Family Support (IFS) Supported Employment Dental OCDD Day (D) Transportation – REG Eye Glasses Night (N) Transportation – W/C Home Health Extended Shared Supports Prevocational Services Hospice LRS IFS – D Day Habilitation Medical Transportation IFS – N Day Hab/ Transportation Mental Health Skilled Nursing Podiatry Services CID Transportation – REG Substance Substitute Family Care Transportation – W/C Prescriptions/Medication DSS Center-Based Respite Adult Companion Care Others Professional Consultation Professional Services Transition Professional Support Skilled Nursing Services Environmental Accessibility Adaptations Specialized Medical Equipment and Supplies Personal Emergency Response System (PERS) Community Integration Development (CID) Supported Independent Living (SIL) Natural Supports One-Time Transitional Expenses Community Supports NOTE: Informed individual of all state plan services. Support Coordinator Initials: ___________