Appendix B - Guidelines and Forms

The forms below are "fillable" forms and can be saved after typing in the information.  If changes need to be made to the completed form at a later time, you will need to make sure you have the most recent form of Adobe to do so.  You can update your Adobe program free of charge at: Get Adobe.Com.

  • OBRA-1 Guidelines
  • OBRA-1 - Initial Screen
  • DDPAS-2 - Intake, Assessment & Determination Summary
  • DDPAS-3 - Medication Review
  • DDPAS-4 - 24-Hour Nursing Care Determination
  • DDPAS-5 - Determination of Mental Retardation or Related Condition & Associated Treatment Needs
  • DDPAS-6 - Identification of Service Needs
  • DDPAS-7 - Authorization for Release of Information
  • DDPAS-8 - Guardianship Screen
  • DDPAS-9 - Retirement from Active Treatment
  • DDPAS-10 - Determination Summary & Presentation and Selection of Service Options