Self Direct Option Forms and Resources

For your convenience, all of the forms that were provided during the enrollment process and training session are also available here.  The documents can be completed electronically and returned via email to your Skills Trainer.  

Checklist (HBC and PDN) 

Checklist (HCB) 

Confidentiality Policy (required for HBC and PDN)

Consumer Information Form (required for all programs) 

Contact and Visit Log (required for HCB only)

Criminal Background Check and CNA Registry Check Form (required for HBC and PDN) 

Demonstration of Competency Form (required for HBC and PDN)

Drug, Tobacco, and Alcohol-Free Workplace Policy (required for HBC and PDN) 

Memorandum of Agreement (required for all programs)

Orientation Statement (required for HBC and PDN)

Plan of Care Employee Assignment Form (required for all programs)

Statement of Competency Certification (required for HCB only)

Training Manual


Program Regulations

Ch. I - Section 1: General Administrative Policies and Procedures

Ch. II - Section 19: Home and Community Benefits for the Elderly and Adults with Disabilities

Ch. II - Section 96: Private Duty Nursing and Personal Care Services

Section 63:   In-Home and Community Support Services for Elderly and Other Adults


Fiscal Intermediaries

Attendant Services

GT Independence

Public Partnerships (PPL)

SPLLC