Legal Relationships Parent(s) of minor child who retain parental rights: Legal Representative/Guardian(s), Scope of if any: authority: Designated Representative(s) for service planning, if any: Designated Representative(s) for employer representative/employer of record issues, if any: Health Care Representative, if any: Appointment Date: Self-Appointed ISP Team Appointed Representative Payee(s), if any: Conservator(s), if any: Any other Legal Documents on file limiting personal decision making: Acknowledgments Describe the supports the person needs to understand his/her rights or to Check here if no understand this plan, if any: Indicate who will be responsible for supporting the person and support is needed timelines for completing this.
Legal Relationships Parent(s) of minor child who retain parental rights: Legal Representative/Guardian(s), if any: Scope of authority: Designated Representative(s) for service planning, if any: Designated Representative(s) for employer representative/employer of record issues, if any: Health Care Representative, if any: Appointment Date: Self-Appointed ISP Team Appointed Representative Payee(s), if any: Conservator(s), if any: Any other Legal Documents on file limiting personal decision making: Acknowledgments Describe the supports the person needs to understand his/her rights or to understand this plan, if any: Indicate who will be responsible for supporting the person and timelines for completing this. Check here if no support is needed
4-Large_Print_ISP_6-18-2015.docx