Technical Assistance Request

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This request form is for providers transitioning into LTSS to give information and insight on their unique needs as they partake in the transition process.

All requests will be coordinated by Regional Offices. Please do not reach out to Early Adopter Group providers with your requests.

Thank you!

İlerleme durumunu kaydetmek için Google'da oturum açın Daha fazla bilgi

E-posta *

What is your organization name? *

Who is the best point of contact for your organization? Please provide their name, email address, and phone number *

Please select the region where your administrative office is located.

CMRO

ESRO

SMRO

WMRO

Seçimi temizle

What services are you transitioning?

Meaningful Day Services (Career Exploration, CDS, Day Hab, Employment Services, Supported Employment)

Residential Services (Community Living Group Home, Community Living Group Home-Enhanced, Shared Living)

Support Services (BSS, Family Supports, Housing Support Services, Nursing Services, OHCDS, Remote Support Services, Respite Services)

Diğer:

What is your Go Live date? Please indicate if you do not have a transition date. *

What billing system is your organization using? *

MITC

CIMS

iCare Manager

Social Solutions

Therap

None

Diğer:

Gerekli

Is there any additional information you would like to share to help facilitate matching?

Gönder

Formu temizle

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Bu form State of Maryland alanında oluşturuldu. Kötüye Kullanımı Bildirme

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