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(MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES DIVISION OF SENIOR AND DISABILITY SERVICES HOME AND COMMUNITY BASED SERVICES REFERRALDATE PERSON BEING REFERRED (LAST, FIRST, MI) RACE SEX DOB (MM/DD/YYY)
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Home and community based services refer to a range of services provided in the home and community settings to individuals who need assistance with daily activities.
Individuals who are in need of home and community based services or their legal guardians are required to file for these services.
To fill out home and community based services, individuals or their legal guardians need to contact their local healthcare provider or social services agency for assistance.
The purpose of home and community based services is to support individuals in living independently in their own homes and communities.
Information such as the individual's medical history, daily activities and needs, and contact information must be reported on home and community based services.
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