• Guidance Regarding the Medically Fragile Disability Determination Requirement - (Web) - (PDF) - April 2023
• Clarification Guidance Re: Children's Waiver HCBS Serious Emotional Disturbance (SED) Eligibility Determination Requirements - (Web) - (PDF) - April 2023
• Updated LPHA Guidance and Instructions - (Web) - (PDF) - July 29, 2022

• Serious Emotional Disturbance (SED) LPHA Attestation Form
  • DOH-5275 - updated May 2023 (PDF)
  • Guide to Edits - (Web) - (PDF) - May 2023 (PDF)

DOH-5276 - Freedom of Choice - Effective April 1, 2021

• English (PDF)
• عربى Arabic (PDF)
• Bেঙলি (Bengali) (PDF)
• Kreyòl Ayisyen (Haitian Creole) (PDF)
• Italiana (feminine), Italiano (masculine) Italian (PDF)
• 한국어 (Korean) (PDF)
• Polskie Polish (PDF)
• русский (Russian) (PDF)
• Español (Spanish) (PDF)
• 繁體中文 (Traditional Chinese) (PDF)
• יידיש Yiddish (PDF)

• Disability Review Team Certificate - DOH 5144 (PDF)
• Childhood Medical Disability Report - DOH-5151 (PDF)
• Questionnaire of School Performance - DOH-5152 (PDF)
• Description of Child´s Activities - DOH-5153 (PDF)
• Disability Questionnaire - DOH-5139 (PDF)
• Authorization for Release of Health Information Pursuant to HIPAA - DOH 5173 (PDF)

DOH-5287 Form

DOH-5288 Form

• English (PDF)
• Bengali (PDF)
• 中文 (Chinese) (PDF)
• Kreyòl Ayisyen (Haitian-Creole) (PDF)
• 한국어 (Korean) (PDF)
• Русский (Russian) (PDF)
• Español (Spanish) (PDF)

• Considerations for Determining HCBS Eligibility for the Serious Emotional Disturbance (SED) Target Population - (Web) - (PDF) - (Recording) - April 19, 2023
• Updates and Clarification Regarding:
  • Medically Fragile (MF) Population HCBS LOC Determination: - (Web) - (PDF) - (Recording) - April 6, 2023
  • Serious Emotional Disturbance (SED) Target Population HCBS LOC Eligibility Determination - (Web) - (PDF) - (Recording) - April 4, 2023