Get Tx Gulf Coast Center Respite Plan Contract For Service Delivery 2014-2025

Filling out the TX Gulf Coast Center Respite Plan Contract For Service Delivery is a crucial step for those seeking respite services. This guide aims to provide clear and supportive instructions to help individuals complete the form efficiently and correctly.

Follow the steps to successfully complete your respite plan contract.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by indicating whether this is an annual plan, an update, or another category by checking the appropriate box. Provide the effective dates of the respite plan by filling in the starting date and confirming it ends on 08/31/2015, unless circumstances change.
3. Fill in the personal details section, including the name, case number, address, city, zip code, and both home and cell phone numbers. Additionally, provide an email address for communication purposes.
4. Identify the parent or guardian responsible by filling in their name. This ensures that the designated caregiver is acknowledged.
5. In the emergency information section, specify emergency contacts, such as a name and phone number of a person not living with you, and an out-of-area contact for crisis situations.
6. List the physician's name and contact number alongside the hospital information to access immediate medical assistance if required.
7. If applicable, include the contact details of your IDD service coordinator.
8. Address the specific services needed by circling or specifying any special assistance required, such as eating assistance or adaptive aids.
9. Detail the individual’s interests regarding activities they enjoy, offering a personalized approach to respite services.
10. List all individuals residing in your household, detailing their names, relationships, and ages to maintain an accurate record.
11. Select the service package option and fill in the required hours for each quarter. Keep in mind that unused hours will not carry over into the next month.
12. Provide contact information for your chosen contract respite provider. Ensure you have selected from the approved provider pool or your own choice.
13. Review the emergency procedures specifically related to weekend respite services, detailing any individual-specific emergency measures if needed.
14. Sign and date the plan, confirming your understanding of the conditions outlined within the document.
15. Finalize by saving your changes and choosing to download, print, or share the filled-out form as necessary.

Complete your TX Gulf Coast Center Respite Plan Contract For Service Delivery online today to ensure you receive the necessary respite services.