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Form #5: page 1 of 2 STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES - DIVISION OF DEVELOPMENTAL DISABILITIES Medical Form for Adults Name: Age: DOB: Male Female Health Insurance #: SS#: Exam Date:.

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[PDF] Form #5: page 1 of 2 DDD Day Program Manual...
DDD Day Program Manual 11/06. Forms: Form F5. STATE OF NEW JERSEY. DEPARTMENT OF HUMAN...
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To meet the functional criteria for a developmental disability, you must provide documentation that you have a chronic physical and/or intellectual disability that began before you were 22 years old, is expected to be lifelong, and limits your ability to care for yourself and live on your own.

Call 1-800-832-9173 (then press 1) to report suspected abuse, neglect or exploitation of an individual with an intellectual or developmental disability.

Apply to Become a Provider Step 1: Apply for an NPI for Every Service Location. ... Step 2: Complete the Combined Application to Become a Medicaid/DDD Approved Provider. ... Step 3: Submit the Combined Application By Mail*

Complete and signed DDD Application for Eligibility Determination. Proof of citizenship including copy of United States birth certificate or legal permanent resident documentation. Copy of medical insurance (if applicable)

To meet the functional criteria for a developmental disability, you must provide documentation that you have a chronic physical and/or intellectual disability that began before you were 22 years old, is expected to be lifelong, and limits your ability to care for yourself and live on your own.

Support Coordinator State of NJ Requirements A Bachelor's degree in any subject. One year of direct experience with adults (18+) with developmental or intellectual disabilities including professional, volunteer, and family experience. Ability to pass fingerprinting, drug screening, and criminal background checks.

DDD administers two Medicaid waiver programs, the Supports Program and Community Care Program. Through enrollment in one of these programs, individuals can receive home and community based services based on their assessed needs and individualized budget.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232