I understand I have a choice to receive services in the community. Community Supports for Community Transition are available to help me. I can choose to accept or decline these services.
If I accept these services, I will receive assistance from Connections Care Home Consultants to move into a community-based setting like an assisted living facility. They will help me find a place, coordinate paperwork, and ensure I am settled in. This will be authorized and paid for by my Managed Care Plan.
If I decline these services, I am choosing to remain where I am, and I will not receive the transition support services offered by this program at this time.
Signature
By signing below, I acknowledge that under penalty of perjury, I am the member or an authorized representative legally empowered to sign on behalf of the member.
I am the: