| Reference No. |
Reference Name |
Link |
Description |
| Ref-01203 |
Application for Services (Form 10-007) |
http://flrules.org/Gateway/reference.asp?No=Ref-01203 |
Eligibility Application for Services from the Agency for Persons with Disabilities (Englis...
|
| Ref-04209 |
APD 10-002, APD Incident Reporting Form |
http://flrules.org/Gateway/reference.asp?No=Ref-04209 |
Agency Incident Reporting Form
|
| Ref-04210 |
APD 2014-02 Facility Inspection Form |
http://flrules.org/Gateway/reference.asp?No=Ref-04210 |
Agency Facility Inspection Form
|
| Ref-04211 |
Zero Tolerance Classroom Participants Manual |
http://flrules.org/Gateway/reference.asp?No=Ref-04211 |
Agency Zero Tolerance Classroom Participants Manual
|
| Ref-04212 |
Zero Tolerance Facilitator's Guide |
http://flrules.org/Gateway/reference.asp?No=Ref-04212 |
Agency Zero Tolerance Facilitator's Guide
|
| Ref-04213 |
Zero Tolerance- a statewide initiative to end abuse, neglect, and exploitation |
http://flrules.org/Gateway/reference.asp?No=Ref-04213 |
Agency Powerpoint: Zero Tolerance- a statewide initiative to end abuse, neglect, and explo...
|
| Ref-04405 |
APD 2014-01- Facility Application Form |
http://flrules.org/Gateway/reference.asp?No=Ref-04405 |
|
| Ref-04406 |
APD 2014-03- Foster Care Facility Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-04406 |
|
| Ref-04407 |
APD 2014-04- Group Home Facility Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-04407 |
|
| Ref-04408 |
APD-2014-05- Residential Habilitation Center Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-04408 |
|
| Ref-04409 |
APD-2014-06-Comprehensive Transitional Education Program Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-04409 |
|
| Ref-04410 |
APD-2014-07- General Facility Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-04410 |
|
| Ref-05077 |
APD Health Facility Checklist |
http://flrules.org/Gateway/reference.asp?No=Ref-05077 |
APD Health Facility Checklist
|
| Ref-07071 |
Amount Implementation Meeting (AIM) Worksheet - APD 2015-01 |
http://flrules.org/Gateway/reference.asp?No=Ref-07071 |
|
| Ref-07072 |
Florida Medicaid Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook |
http://flrules.org/Gateway/reference.asp?No=Ref-07072 |
|
| Ref-07073 |
Regional iBudget Provider Enrollment Application - Waiver Support Coordinator (WSC) - APD 2015-02 |
http://flrules.org/Gateway/reference.asp?No=Ref-07073 |
|
| Ref-07074 |
Regional iBudget Provider Enrollment Application - Non WSC - APD 2015-03 |
http://flrules.org/Gateway/reference.asp?No=Ref-07074 |
|
| Ref-07075 |
Questionnaire for Situational Information (QSI) |
http://flrules.org/Gateway/reference.asp?No=Ref-07075 |
|
| Ref-07076 |
Provider Expansion Request Form APD 2015-04 |
http://flrules.org/Gateway/reference.asp?No=Ref-07076 |
|
| Ref-09533 |
APD Incident Reporting form APD OP 3-0006 |
http://flrules.org/Gateway/reference.asp?No=Ref-09533 |
APD Incident Reporting Form APD OP 3-0006, effective May 25, 2018.
|
| Ref-10587 |
Authorization for Medication Administration |
http://flrules.org/Gateway/reference.asp?No=Ref-10587 |
Authorization for Medication Administration
|
| Ref-10588 |
Informed Consent for Medication Administration |
http://flrules.org/Gateway/reference.asp?No=Ref-10588 |
Informed Consent for Medication Administration
|
| Ref-10589 |
Medication Administration Trainer Application Form |
http://flrules.org/Gateway/reference.asp?No=Ref-10589 |
Medication Administration Trainer Application Form
|
| Ref-10590 |
Certificate of Completion for Basic Medication Administration Training |
http://flrules.org/Gateway/reference.asp?No=Ref-10590 |
Certificate of Completion for Basic Medication Administration Training
|
| Ref-10591 |
Basic Medication Administration Validation Certificate |
http://flrules.org/Gateway/reference.asp?No=Ref-10591 |
Basic Medication Administration Validation Certificate
|
| Ref-10592 |
Prescribed Enteral Formula Administration Certificate of Completion |
http://flrules.org/Gateway/reference.asp?No=Ref-10592 |
Prescribed Enteral Formula Administration Certificate of Completion
|
| Ref-10593 |
Validation Trainer Application Form |
http://flrules.org/Gateway/reference.asp?No=Ref-10593 |
Validation Trainer Application Form
|
| Ref-10594 |
Prescribed Enteral Formula Administration Validation Certificate |
http://flrules.org/Gateway/reference.asp?No=Ref-10594 |
Prescribed Enteral Formula Administration Validation Certificate
|
| Ref-10595 |
Certificate of Completion for Basic Medication Adminsitration Annual Update |
http://flrules.org/Gateway/reference.asp?No=Ref-10595 |
Certificate of Completion for Basic Medication Adminsitration Annual Update
|
| Ref-10596 |
Certificate of Completion for Prescribed Enteral Formula Administration Annual Update |
http://flrules.org/Gateway/reference.asp?No=Ref-10596 |
Certificate of Completion for Prescribed Enteral Formula Administration Annual Update
|
| Ref-10597 |
Temporary Validation Form |
http://flrules.org/Gateway/reference.asp?No=Ref-10597 |
Temporary Validation Form
|
| Ref-10598 |
Medication Error Report |
http://flrules.org/Gateway/reference.asp?No=Ref-10598 |
Medication Error Report
|
| Ref-10600 |
Controlled Medication Count Form |
http://flrules.org/Gateway/reference.asp?No=Ref-10600 |
Controlled Medication Count Form
|
| Ref-10601 |
Medication Administration Record |
http://flrules.org/Gateway/reference.asp?No=Ref-10601 |
Medication Administration Record
|
| Ref-10602 |
Off-Site Medication Form |
http://flrules.org/Gateway/reference.asp?No=Ref-10602 |
Off-Site Medication Form
|
| Ref-10756 |
Medication Destruction Record |
http://flrules.org/Gateway/reference.asp?No=Ref-10756 |
|
| Ref-12444 |
Regional iBudget Provider Enrollment Application - WSC |
http://flrules.org/Gateway/reference.asp?No=Ref-12444 |
Form 65G-4.0215 A
|
| Ref-12445 |
Verification of Available Services |
http://flrules.org/Gateway/reference.asp?No=Ref-12445 |
Form 65G-4.0213 B
|
| Ref-12446 |
Provider Expansion Request |
http://flrules.org/Gateway/reference.asp?No=Ref-12446 |
Form 65G-4.0215 C
|
| Ref-12447 |
WSC Job Aid for Cost Plans and Significant Additional Needs Documentation |
http://flrules.org/Gateway/reference.asp?No=Ref-12447 |
Form 65G-4.0213 D
|
| Ref-12459 |
Amount Implementation Meeting Worksheet |
http://flrules.org/Gateway/reference.asp?No=Ref-12459 |
Form 65G-4.0213 A
|
| Ref-12590 |
Regional iBudget Provider Enrollment Application - Non-WSC |
http://flrules.org/Gateway/reference.asp?No=Ref-12590 |
APD Form 65G-4.0215 B
|
| Ref-12650 |
Qualified Organization Application - APD Form 65G-14.002 A |
http://flrules.org/Gateway/reference.asp?No=Ref-12650 |
The application that must be submitted for approval to become a Qualified Organization.
|
| Ref-12651 |
Qualified Organization Medicaid Waiver Services Agreement - APD Form 65G-14.002 B |
http://flrules.org/Gateway/reference.asp?No=Ref-12651 |
The Medicaid Waiver Services Agreement to be signed by APD and each approved Qualified Org...
|
| Ref-12652 |
Invitation to Take Client Satisfaction Survey - APD Form 65G-14.003 A |
http://flrules.org/Gateway/reference.asp?No=Ref-12652 |
An invitation for clients or, if applicable, their legal representative to take a client s...
|
| Ref-12653 |
Support Coordinator Dual Employment MWSA Attachment - APD Form 65G-14.004 A |
http://flrules.org/Gateway/reference.asp?No=Ref-12653 |
Attachment to a Support Coordinator's Medicaid Waiver Services Agreement reflecting an app...
|
| Ref-12654 |
Certification of Mentoring Program Completion - APD Form 65G-14.0043 A |
http://flrules.org/Gateway/reference.asp?No=Ref-12654 |
Certification that a mentee who did not have prior experience working as a support coordin...
|
| Ref-12655 |
Certification of Mentoring Program Completion for Existing WSCs - APD Form 65G-14.0043 B |
http://flrules.org/Gateway/reference.asp?No=Ref-12655 |
Certification that a mentee who had prior experience but less than 12 months' experience w...
|
| Ref-12745 |
Support Coordinator In-Service Training Verification |
http://flrules.org/Gateway/reference.asp?No=Ref-12745 |
|
| Ref-14194 |
State Institution Claims Program Form APD Form 65G-15.002A |
http://flrules.org/Gateway/reference.asp?No=Ref-14194 |
APD Form 65G-15.002A
|
| Ref-14949 |
APD Form 65G-13.004 A – Individual Financial Profile |
http://flrules.org/Gateway/reference.asp?No=Ref-14949 |
A profile developed by a client of the Agency or a client’s legal representative and the c...
|
| Ref-14984 |
Regional iBudget Provider Enrollment Application - Non-WSC APD Form 65G-4.0215 B |
http://flrules.org/Gateway/reference.asp?No=Ref-14984 |
|
| Ref-14985 |
Provider Expansion Request APD Form 65G-4.0215 C |
http://flrules.org/Gateway/reference.asp?No=Ref-14985 |
|
| Ref-15472 |
APD Form 65G-13.008 A Room and Board Reimbursement Form |
http://flrules.org/Gateway/reference.asp?No=Ref-15472 |
Form an APD licensed facility must submit to request reimbursement for monthly room and bo...
|