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The DOH CDPAP 01 form is a document used in the Consumer Directed Personal Assistance Program (CDPAP) administered by the New York State Department of Health (DOH). CDPAP is a Medicaid program that allows individuals with disabilities or chronic illnesses to hire and manage their own personal assistants, including family members or friends. The DOH CDPAP 01 form is one of the application forms required to enroll in the CDPAP program. It collects essential information about the consumer, their medical condition, and their preferred personal assistant. It also includes the terms of service and responsibilities of both the consumer and the personal assistant. The form needs to be completed and submitted to the local DOH office or a CDPAP fiscal intermediary to initiate the enrollment process.

The DOH CDPAP 01 form is typically required to be filed by the consumer or their designated representative for the Consumer Directed Personal Assistance Program (CDPAP) in the state of New York. This form is used to apply for enrollment in the program and to select personal assistants for the consumer's care.

To fill out the DOH CDPAP-01 form, follow these steps: 1. Begin by entering the date at the top of the form. 2. Fill in the Consumer's Name, which refers to the person receiving care. 3. Enter the CDPAP ID, which is the identification number assigned to the CDPAP program. 4. Fill in the date of birth of the Consumer. 5. Provide the Consumer's social security number. 6. Enter the Consumer's address, including street, city, state, and zip code. 7. Fill in the Consumer's phone number, including the area code. 8. Next, provide the Consumer's Medicaid ID number. 9. Enter the Consumer's Medicaid Case Number. 10. Indicate the number of family members in the household by selecting the appropriate option. 11. If applicable, select the appropriate statements regarding the Consumer's residence. 12. Fill in the requested information about the Consumer's income, including Social Security income, Supplemental Security Income, or other public assistance programs. 13. Provide any additional information about the Consumer's income or assets, if applicable. 14. If the Consumer has an assigned Managed Care Organization (MCO), fill in the MCO name and phone number. 15. Sign and date the form at the bottom. 16. If you are filling out the form as a representative of the Consumer, indicate your relationship to the Consumer and sign your name. 17. If you are not the Consumer or representative but are assisting in completing the form, indicate your name and contact information at the bottom. 18. Review the completed form for accuracy and completeness before submitting it to the appropriate party.

The DOH CDPAP 01 form is used for the Consumer Directed Personal Assistance Program (CDPAP) in the state of New York. The purpose of this form is to determine the eligibility of a consumer (recipient of care) for enrollment in the CDPAP. It collects various information such as the consumer's personal details, medical condition, and need for personal assistance. The form is also used to designate a representative or caregiver who will be responsible for providing the personal assistance services. Overall, the purpose of the DOH CDPAP 01 form is to assess the consumer's eligibility and facilitate their enrollment in the CDPAP.

The DOH CDPAP 01 form is used for enrollment and to obtain the necessary information of the Consumer Directed Personal Assistance Program (CDPAP) participants in New York. The form includes the following information: 1. Consumer Information: Name, address, date of birth, gender, social security number, contact information, and Medicaid number of the consumer. 2. Designated Representative(s): If the consumer is unable to manage their own affairs, the person(s) appointed to make decisions on their behalf is listed here. If none, it may be left blank. 3. Managed Care Organization (MCO)/ Fiscal Intermediary (FI): The names and contact information of the organization(s) responsible for managing the consumer's services and financial aspects. 4. Medicaid Service Coordinator (MSC)/ Care Manager: The contact information of the person responsible for coordinating the consumer's services. 5. Consumer's Medical Diagnosis: Information about the consumer's medical condition, diagnosis, and any special needs that require attention or monitoring. 6. Physician's Information: The name, address, and contact information of the consumer's primary physician and other relevant healthcare providers. 7. Authorized Representative and Consent: If the consumer wants to authorize someone to act on their behalf regarding CDPAP enrollment and services, their information is provided here. 8. Consent for Release and Exchange of Health Information: The consumer's consent to release and exchange their health information among authorized parties involved in their CDPAP care. 9. Consumer's Signature and Date: The signature of the consumer or the authorized representative, along with the date of signing the form. It's worth noting that the provided information may vary slightly depending on the specific version or updated form of DOH CDPAP 01 used by the New York Department of Health.

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