FMS Waiver

Parent/Caregiver Information

• PARENT INFO SHEET- VEHICLE MODIFICATIONS

• PARENT INFO SHEET- ENVIRONMENTAL MODIFICATIONS

• PARENT INFO SHEET- ADAPTIVE/ASSITIVE TECHNOLOGY

Vendor/Contractor Information

• Approved List of Evaluators

HHCM/CYES FORMS:

• Care Manager Bid Justification Form
• Change Order Form Template
• Description and Cost Projection Form
• Due Diligence Template
• Landlord Agreement Form
• Parent/Caregiver Agreement
• Pre-Project Payment Request Form
• Project Cover Sheet & Checklist- AAT
• Project Cover Sheet & Checklist - EMOD
• Project Cover Sheet & Checklist - VMOD
• Vehicle Information Sheet

HHCM/CYES INFORMATION:

• POLICY (TBD)
• Care Manager/CYES Training- Project Submission & Requirements
• Sign up for our FMS Email Listserv HERE to stay up to date!

PROJECT REQUEST SUBMISSION FORM

If you have any questions regarding FMS Waiver services, please contact fms@childrenshealthhome.org or call 855-209-1142.