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DADS Provider Communications

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Forms updates

Form 8578 (Intellectual Disability/Related Condition Assessment), which as previously titled "Mental Retardation/Related Condition Assessment," has been updated to include respectful language. Additional minor changes were made including:

  • Elimination of references to the Consolidated Waiver Program (CWP)
  • Revision to Item #72 (for ICF only), which allows for an APN or PA to attest that the physician whose license is noted in Item #55 delegated Items 19 and 48-51 to the APN or PA
  • Revisions to the form’s instructions

Please begin using this revised version of Form 8578.  Entities with existing stock of hard copies of the previous version of Form 8578 have until June 1, 2012, to begin using the revised version.

Additionally, Form 8662 (Related Conditions Eligibility Screen Instrument) and its instructions have been updated to include respectful language.

Posted: 2/16/2012

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