DDP Forms/Tools


When completing forms in Excel and Word formats, only save your document using the "save as" option when exiting. Please save your document to your personal files prior to exiting.

Annual Provider Training Requirements

Behavior Support Waiver Services


  • Eligibility Determination Form - Adult - 11/01/13 (WORD)
  • Eligibility Determination Form - Children - 11/01/13 (WORD)

FES Title XX and Part C Early Intervention Forms/Tools

Autism Endorsement

To request forms for the Autism Endorsement, please contact:

Melinda Cummings, Medicaid Waiver Specialist
(406) 444-2695

Application for Title XX Funding

For Title XX applications, please contact your Regional Office

Family Support Specialist

FES Title XX and Part C Early Intervention

General Event/Incident Management Off-Line Forms

NOTE: Offline forms are only to be used in cases where the reporter is unable to access the Therap online reporting site.  To complete the GER/Incident Report, you must complete both the Therap GER/Incident Report Off-line Form plus the appropriate attachment related to the Type of Event.

Link to THERAP offline forms

Offline forms on Therap that apply:

  • General Event Reports
  • Injury: Form-GER
  • Medication Error: Form-GER
  • Restraint Related to Behavior: Form-GER
  • Restraint Other: Form-GER
  • Other: Form-GER

 Individual Cost Plans (ICP) and Invoicing Tools

ICP Document Development

ICP Calculators and Invoicing


Day and Residential Services





Supported Living and Follow Along OTHER



Medical and Nursing Forms

Medical Group Home Screening

Personal Support Plans (PSP)

Urgent Need and Emergency Services Forms

Waiver Forms/Tools

Children's 0208 Waiver Services (CWS) Documents


Mini Mona


Individual Goods and Services Guides -


For the 0208 Comprehensive Waiver

 For the 0667 Children’s Autism Waiver

Environmental Modification/ Adaptive Equipment Guides -

For the 0208 comprehensive waiver and 0667 Children’s Autism Waiver

Referral - Adult

For the 0208 Comprehensive Services Waiver

If you are still using some forms that have been taken down, please contact your Regional Manager

Waiver 5 Forms

0667 Children's Autism Waiver (CAW)


CAW (no new applications)


  • Waiver 5 CAW Services Freedom of Choice and Consent - 07/01/13
  • Waiver 5 Freedom of Choice Addendum - 07/01/13