Downloadable Waiver Forms & Participant Resources

Easily access and download all Priority Care SHS waiver documents, forms, and program guidelines. This resource hub includes participant rights, service coordination forms, TBI waiver materials, housing guidelines, cost projections, and provider selection tools—supporting participants, families, and care coordinators.

Waiver Program Policies

NHTD/TBI Waiver Transportation Guidelines (2023)
TBI Waiver Renewal (2022)

Resource Directories & Contact Lists

RRDCs by Counties Served (Attachment 1)
Waiver Services Contact List (C-1.5)

Participant Rights & Contracts

Waiver Participant Attestation (Attachment 7)
Waiver Participant Contract (Attachment 9)
Waiver Participant Rights

Assessments & Evaluations

2019 TBI ISP Template
TBI ISP Checklist
UAS Request Form (11.9.17)

Cost Projections & Approvals

Assistive Technology Description & Cost Projection (2020)
E-Mod Description & Cost Projection (2020)
RRDS Approval of Payments for E-Mods (2020)
Payment Request Form & Narrative (Attachment 3)
Budget Form (Attachment 8)
CTS Description & Cost Projection

Service Coordination & Provider Forms

Change in Provider Request
Change in Service Coordinator Form
Provider Selection Form
SC Monthly Note
Service Coordination Selection
Team Meeting Summary Form

Revised Service Plan

PPO (09.2013)
TBI Addendum in Use (2019)
TBI RSP in Use (2019, DOC)
TBI RSP in Use (2019, DOCX)

Housing & Living Support

Housing Subsidy Prior Approval Request (Attachment 2)
HQS Checklist (Attachment 4)
Sample Lease (Attachment 5)
Household Goods Actual Expenditures (Attachment 6)
Housing Manual Update (2019)
Housing Program Guidelines Update (2019)

Have Questions About the Downloadable Forms?

If you have any questions about the waiver forms and participant resources above, please don’t hesitate to give us a call.

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