Office of Children and Family Services

OCFS Forms for Home and Community-Based Services Waiver (B2H)

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Found 94 Form(s) for Home and Community-Based Services Waiver (B2H) below...

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Name
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Number
Home and Community-Based Services Waiver (B2H)

Notificación de la Decisión-Autorización
Notice of Decision-Authorization
Form
OCFS-8009-S
Home and Community-Based Services Waiver (B2H)
Notificación de la Decisión - Discontinuación del Programa de Exención
Notice of Decision - Discontinuance from Waiver Program
Form
OCFS-8011A-S
Home and Community-Based Services Waiver (B2H)
Notificación de la Decisión-Discontinuación de Servicios de Exención, Proveedor(es) de Servicio(s) y/o Reducción de Servicio(s)
Notice of Decision-Discontinuance of Waiver Service(s), Service Provider(s) an/or Reduction of Service(s)
Form
OCFS-8011B-S
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Discontinuance from Waiver Program
決定通知−中止
減免計畫
Form
OCFS-8011A-TC
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Discontinuance from Waiver Program
УВЕДОМЛЕНИЕ О РЕШЕНИИ: ПРЕКРАЩЕНИЕ УЧАСТИЯ
В АЛЬТЕРНАТИВНОЙ ПРОГРАММЕ
Form
OCFS-8011A-RU
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Discontinuance from Waiver Program
결정 통지서 – 면제 프로그램
중단
Form
OCFS-8011A-KO
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Discontinuance from Waiver Program
AVVISO DI DECISIONE - INTERRUZIONE DEL
PROGRAMMA WAIVER
Form
OCFS-8011A-IT
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Discontinuance from Waiver Program
AVI POU DESIZYON - SISPANSYON NAN
PWOGRAM EGZANPSYON
Form
OCFS-8011A-HC
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Denial of Enrollment
AVI POU DESIZYON - REFI POU ENSKRIPSYON
Form
OCFS-8010A-HC
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Denial of Enrollment
AVVISO DI DECISIONE - DINIEGO DELL’ISCRIZIONE
Form
OCFS-8010A-IT
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Denial of Enrollment
결정 통지서 – 등록 거부
Form
OCFS-8010A-KO
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Denial of Enrollment
Form
OCFS-8010A-RU
Home and Community-Based Services Waiver (B2H)
Notice of Decision-Denial of Enrollment
決定通知– 拒絕註冊
Form
OCFS-8010A-TC
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information
의료 정보 공개 승인
Form
OCFS-8001-KO
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information
健康資訊披露授權
Form
OCFS-8001-CH
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information
СОГЛАСИЕ НА ПЕРЕДАЧУ МЕДИЦИНСКОЙ ИНФОРМАЦИИ
Form
OCFS-8001-RU
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information
AUTORIZZAZIONE ALLA COMUNICAZIONE DI INFORMAZIONI SANITARIE
Form
OCFS-8001-IT
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information
OTORIZASYON POU DIVILGE ENFÒMASYON SOU SANTE
Form
OCFS-8001-HC
Home and Community-Based Services Waiver (B2H)
Autorización para Comunicar Información de Salud
Authorization for Release of Health Information
Form
OCFS-8001-S
Home and Community-Based Services Waiver (B2H)
Entendiendo el Programa de Exención del Medicaid B2H
Understanding the Bridges to Health Medicaid Waiver Program
Form
OCFS-8003S
Home and Community-Based Services Waiver (B2H)
Formulario de Libre Selección
Freedom of Choice Form
Form
OCFS-8002S
Home and Community-Based Services Waiver (B2H)
Notificacion de la Decision-Denegacion de Inscripcion
Notice of Decision – Denial of Enrollment
Form
OCFS-8010AS
Home and Community-Based Services Waiver (B2H)
Formulario de Solicitud de Inscripción
Application Form for Enrollment
Form
OCFS-8004S
Home and Community-Based Services Waiver (B2H)
Formulario de Exención de los Derechos del Participante
Waiver Participants Rights Form
Form
OCFS-8008S
Home and Community-Based Services Waiver (B2H)
Formulario de Reautorización
Reauthorization Form
Form
OCFS-8014S
Home and Community-Based Services Waiver (B2H)
Medication Error Report (PDF)
Form
OCFS-8036
Home and Community-Based Services Waiver (B2H)
Medication Error Report (WORD)
Form
OCFS-8036
Home and Community-Based Services Waiver (B2H)
Schedule A - Waiver Service Provider Commitment form (PDF)
Form
OCFS-8035
Home and Community-Based Services Waiver (B2H)
Schedule A - Waiver Service Provider Commitment form (WORD)
Form
OCFS-8035
Home and Community-Based Services Waiver (B2H)
Qualification Form (PDF)
Form
OCFS-8034
Home and Community-Based Services Waiver (B2H)
Qualification Form (WORD)
Form
OCFS-8034
Home and Community-Based Services Waiver (B2H)
Transition Plan (PDF)
Form
OCFS-8030
Home and Community-Based Services Waiver (B2H)
Transition Plan(WORD)
Form
OCFS-8030
Home and Community-Based Services Waiver (B2H)
Accessibility Modifications and or Adaptive and Assistive Equipment Discription Cost Projection and Final Cost (PDF)
Form
OCFS-8028
Home and Community-Based Services Waiver (B2H)
Accessibility Modifications and or Adaptive and Assistive Equipment Discription Cost Projection and Final Cost (WORD)
Form
OCFS-8028
Home and Community-Based Services Waiver (B2H)
Contact Information List (PDF)
Form
OCFS-8027
Home and Community-Based Services Waiver (B2H)
Contact Information List (WORD)
Form
OCFS-8027
Home and Community-Based Services Waiver (B2H)
Loss of Eligibility Recommendation Form (PDF)
Form
OCFS-8026
Home and Community-Based Services Waiver (B2H)
Loss of Eligibility Recommendation Form (WORD)
Form
OCFS-8026
Home and Community-Based Services Waiver (B2H)
Certificate of Attendance (PDF)
Form
OCFS-8025
Home and Community-Based Services Waiver (B2H)
Certificate of Attendance (WORD)
Form
OCFS-8025
Home and Community-Based Services Waiver (B2H)
Grievance - Complaint Packet (PDF)
Form
OCFS-8024
Home and Community-Based Services Waiver (B2H)
Grievance - Complaint Packet (WORD)
Form
OCFS-8024
Home and Community-Based Services Waiver (B2H)
Status Progress Report (WORD)
Form
OCFS-8022
Home and Community-Based Services Waiver (B2H)
Serious Reportable Incident Form (PDF)
Form
OCFS-8021
Home and Community-Based Services Waiver (B2H)
Serious Reportable Incident Form (WORD)
Form
OCFS-8021
Home and Community-Based Services Waiver (B2H)
Detailed Service Plan (PDF)
Form
OCFS-8020
Home and Community-Based Services Waiver (B2H)
Detailed Service Plan (WORD)
Form
OCFS-8020
Home and Community-Based Services Waiver (B2H)
Progress Notes (PDF)
Form
OCFS-8019
Home and Community-Based Services Waiver (B2H)
Progress Notes (WORD)
Form
OCFS-8019
Home and Community-Based Services Waiver (B2H)
Service Summary Form (PDF)
Form
OCFS-8018
Home and Community-Based Services Waiver (B2H)
Service Summary Form (WORD)
Form
OCFS-8018
Home and Community-Based Services Waiver (B2H)
Individualized health Plan -IHP (EXCEL)
Form
OCFS-8017
Home and Community-Based Services Waiver (B2H)
Individualized health Plan -IHP (PDF)
Form
OCFS-8017
Home and Community-Based Services Waiver (B2H)
Individualized health Plan -IHP (WORD)
Form
OCFS-8017
Home and Community-Based Services Waiver (B2H)
Serious Incident Review Committee Quarterly Report (PDF)
Form
OCFS-8015B
Home and Community-Based Services Waiver (B2H)
Serious Incident Review Committee Quarterly Report (WORD)
Form
OCFS-8015B
Home and Community-Based Services Waiver (B2H)
Health Care Integration Agency Quarterly-Annual Report (PDF)
Form
OCFS-8015A
Home and Community-Based Services Waiver (B2H)
Health Care Integration Agency Quarterly-Annual Report (WORD)
Form
OCFS-8015A
Home and Community-Based Services Waiver (B2H)
Reauthorization Form (PDF)
Form
OCFS-8014
Home and Community-Based Services Waiver (B2H)
Reauthorization Form (WORD)
Form
OCFS-8014
Home and Community-Based Services Waiver (B2H)
Wait List Notification Form (PDF)
Form
OCFS-8012
Home and Community-Based Services Waiver (B2H)
Wait List Notification Form (WORD)
Form
OCFS-8012
Home and Community-Based Services Waiver (B2H)
Notice of Decision Discontinuance of Waiver Services - Service Providers and or Reduction of Services (PDF)
Form
OCFS-8011B
Home and Community-Based Services Waiver (B2H)
Notice of Decision Discontinuance of Waiver Services - Service Providers and or Reduction of Services (WORD)
Form
OCFS-8011B
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Discontinuance from Waiver Program (PDF)
Form
OCFS-8011A
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Discontinuance from Waiver Program (WORD)
Form
OCFS-8011A
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Denial of Waiver Services (PDF)
Form
OCFS-8010B
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Denial of Waiver Services (WORD)
Form
OCFS-8010B
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Denial of Enrollment (PDF)
Form
OCFS-8010A
Home and Community-Based Services Waiver (B2H)
Notice of Decision - Denial of Enrollment (WORD)
Form
OCFS-8010A
Home and Community-Based Services Waiver (B2H)
Notice of Decision- Authorization (PDF)
Form
OCFS-8009
Home and Community-Based Services Waiver (B2H)
Notice of Decision- Authorization (WORD)
Form
OCFS-8009
Home and Community-Based Services Waiver (B2H)
Waiver Participants Rights Form (PDF)
Form
OCFS-8008
Home and Community-Based Services Waiver (B2H)
Waiver Participants Rights Form (WORD)
Form
OCFS-8008
Home and Community-Based Services Waiver (B2H)
Health Care Integrator Selection Form (PDF)
Form
OCFS-8007
Home and Community-Based Services Waiver (B2H)
Health Care Integrator Selection Form (WORD)
Form
OCFS-8007
Home and Community-Based Services Waiver (B2H)
Change of Provider Form (PDF)
Form
OCFS-8006
Home and Community-Based Services Waiver (B2H)
Change of Provider Form (WORD)
Form
OCFS-8006
Home and Community-Based Services Waiver (B2H)
Level of Care for Children with Medical Fragility - MedF Pediatric Patient Review Instrument (PDF)
Form
OCFS-8005C
Home and Community-Based Services Waiver (B2H)
Level of Care for Children with Medical Fragility - MedF Pediatric Patient Review Instrument (WORD)
Form
OCFS-8005C
Home and Community-Based Services Waiver (B2H)
ICF-MR Level of Care Eligibility Determination-LCED Form (PDF)
Form
OCFS-8005B
Home and Community-Based Services Waiver (B2H)
ICF-MR Level of Care Eligibility Determination-LCED Form (WORD)
Form
OCFS-8005B
Home and Community-Based Services Waiver (B2H)
Level of Care for Children with Serious Emotional Disturbances - SED (PDF)
Form
OCFS-8005A
Home and Community-Based Services Waiver (B2H)
Level of Care for Children with Serious Emotional Disturbances - SED (WORD)
Form
OCFS-8005A
Home and Community-Based Services Waiver (B2H)
Application Form for Enrollment (PDF)
Form
OCFS-8004
Home and Community-Based Services Waiver (B2H)
Application Form for Enrollment (WORD)
Form
OCFS-8004
Home and Community-Based Services Waiver (B2H)
Freedom of Choice (PDF)
Form
OCFS-8003
Home and Community-Based Services Waiver (B2H)
Freedom of Choice (DOC)
Form
OCFS-8003
Home and Community-Based Services Waiver (B2H)
Understanding the Bridges to Health Medicaid Waiver Program (PDF)
Form
OCFS-8002
Home and Community-Based Services Waiver (B2H)
Understanding the Bridges to Health Medicaid Waiver Program (WORD)
Form
OCFS-8002
Home and Community-Based Services Waiver (B2H)
Authorization for Release of Health Information (WORD)
Form
OCFS-8001
Home and Community-Based Services Waiver (B2H)
Referral Form (PDF)
Form
OCFS-8000
Home and Community-Based Services Waiver (B2H)
Referral Form (WORD)
Form
OCFS-8000

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