Click on the individual form you wish to view

• Kansas Department for Aging and Disability Services (KDADS) Forms
• Tri-Ko, Inc. CDDO Forms
• BASIS Related Forms
• Quality Oversight Forms

 

Kansas Department for Aging and Disability Services (KDADS) Forms

- HCBS I/DD Manual – Home & Community Bases Services Intellectual/Developmental Disability Fee-for-Service Provider Manual

- KSA 39-2009 Prohibited Offense List – List of Prohibited Offenses for HCBS Providers

- 3161 – Notice of updates and changes to DCF & KDHE

- KanCare Application

 

 

Tri-Ko, Inc. CDDO Forms

- Tri-Ko, Inc. CDDO Brochure – Informative Booklet containing Provider Choice List, Rights & Responsibilities, Dispute Resolution Process, and KanCare Providers

- Tri-Ko, Inc. CDDO Policies & Procedures – Complete Booklet of all of Tri-Ko, Inc. CDDO’s Policies & Procedures

- Eligibility Application Packet – All of the forms needed to determine eligibility for Home & Community Based Services on the Intellectual/Developmental Disability Waiver

- Provider Choice Form

- Provider Choice Form (TCM only)

 

 

 

BASIS Related Forms

- Basic Assessment, Services, & Information System (BASIS) - blank

- Medical Conditions – List of medical conditions that CAN and CANNOT be captured on the BASIS Assessment

- Behavior Definitions – Descriptive list of behaviors that can be tracked for the BASIS Assessment

- Behavior Tracking Form – General form used to track behavior frequency by month

 

 

 

Quality Oversight Forms

- Adverse Incident Report (AIR)– KDADS Form used for identification and follow-up to critical events or incidents that bring harm, or create the potential for harm, to a KDADS program participant.

- AIR User Manual – Official KDADS Manual for performing Adverse Incident Reports

- AIR Protocols and Definitions - Protocol and Definitions for Adverse Incident Reporting

- Critical Incident Report - Form used to report Critical Incidents and Trend Tracking information to the CDDO following submission of Adverse Incident Report to KDADS

- Dispute Resolution Form - Used to present a grievance to the CDDO which has not been solved through the provider's internal grievance procedure

- QA On-Site Visit Form - Used by Quality Assurance Committee Members for on-site quality oversight visits