Forms are available for you to download and complete as you need them. Before filling out packets and forms, it is important to know your role.
Click here or scroll to the bottom of the page to review the different roles to help you determine which forms you need to fill out. If you are unsure on how to complete a form or are unable to find what you need, please contact the Consumer Direct Care Network office at 844-381-4432.
Forms
Services My Way Program
Participant Guide
Participant Guide – Appendix A – Glossary of Key Terms (English)
Participant Guide – Appendix B – Allowable/Non-Allowable Goods and Services (English)
Participant Guide – Appendix C – Sample Job Description (English)
Participant Guide – Appendix D – Sample Interview (English)
Participant Guide – Appendix E – Remediation Training and Termination Process (English)
Participant Guide (Spanish)
Participant Guide – Appendix A – Glossary of Key Terms (Spanish)
Participant Guide – Appendix B – Allowable/Non-Allowable Goods and Services (Spanish)
Participant Guide – Appendix C – Sample Job Description (Spanish)
Participant Guide – Appendix D – Sample Interview (Spanish)
Participant Guide – Appendix E – Remediation Training and Termination Process (Spanish)
Participant/Representative Forms
Department of Health Care Finance Forms
Authorized Representative Designation Form
Authorized Representative Designation Form (Spanish)
Bi-Weekly Progress Notes (Spanish)
Individual Directed Good and Services Allowable and Non-Allowable List
Natural Supports/Unpaid Back-up Designation Form
Natural Supports/Unpaid Back-up Designation Form (Spanish)
Participant Consent Form (Spanish)
Participant/Representative-Employer Agreement
Participant/Representative-Employer Agreement (Spanish)
Remediation, Training and Termination Protocol
Participant Directed Worker (PDW) Forms
General Forms
What’s My Role?
Participant Directed Worker (PDW) – The person hired to provide care or supports. This person is sometimes called a caregiver.
Participant – The person receiving services and supports.
Representative – The person who willingly accepts responsibility for performing employer and budget management tasks on behalf of a participant enrolled in the Services My Way program.