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Form 8578, Intellectual Disability/Related Condition Assessment | Texas Health and Human Services


Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
Right Click for PC or
Ctrl + Click for Mac on the PDF link and click “
Save link as” from the menu.
Select the folder you want to save the file in and then click
Save.
Right Click for PC or
Ctrl + Click for Mac, then select
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC.
Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message. ....

United States , Employment Services , Program Eligibility , International Classification Of Diseases , Developmental Disability Authority , Day Services , Service Score , Agency Planning , Texas Education Agency , Applicant Health Insurance Claim , Service Provider , Service Level , Waivers Community Services Utilization , Department Of Assistive , Behavior Program , Community Living Assistance , Service Coordinator , Applicable Texas Health , Texas Medicaid Healthcare Partnership , Leiter International Performance Scale , Salvation Army , Rehabilitative Services , Human Services Commission , Texas Health , Related Condition Assessment , Care Facilities ,

Form 8578-CFC, Intellectual Disability/Related Condition Assessment for CFC | Texas Health and Human Services


Enter the legal name of the LIDDA completing the form.
2. LIDDA Component Code
3. LIDDA Mailing Address
80. Managed Care Organization (MCO) or Department of State Health Services (DSHS) Name
Enter the name of the MCO chosen by the individual for CFC services or name of DSHS.
81. MCO Component Code
Enter the component code associated with the MCO chosen by the individual for CFC services. If DSHS, leave this field blank.
82. Plan Code
4. Individual’s Name (Last/First/Middle)
Enter the individual s last name, first name and middle name or initial.
10. Individual’s Date of Birth
Enter the individual s date of birth in MM-DD-YYYY format. ....

United States , Community First Choice , International Classification Of Diseases , Care Organization , Community Living Assistance , Department Of State Health Services , Texas Health , Leiter International Performance Scale , Agency Planning , Human Services Commission , Developmental Disabilities Authority , Related Conditions Assessment , Intermediate Care Facility , Intellectual Disability , Related Conditions , Developmental Disability , Waiver Programs , Support Services , Deaf Blind , Multiple Disabilities , Community Based Services , Texas Home Living , Local Intellectual , Client Assignment , Utilization Management , Waiver Eligibility ,