TX HHS Form 6501. Individual Program Plan

The TX HHS Form 6501, Individual Program Plan, is a crucial tool for individuals with Deaf Blindness and Multiple Disabilities (DBMD) to develop a personalized plan for their care. This form helps solve the problem of creating a comprehensive plan that addresses an individual's unique needs, goals, and preferences.

The form requires important information such as the individual's name, date of birth, social security number, Medicaid and Medicare numbers (if applicable), employment status, education level, and service planning team members. The Individual Plan of Care (IPC) section outlines the effective period, from and to dates, and the services currently being received.

This form should be used by individuals with DBMD who are enrolled in the TX HHS DBMD Waiver program. It is essential for Program Providers to complete this form in collaboration with the individual's Service Planning Team (SPT) members, including the Legally Authorized Representative (LAR), and the Program Director. The one-page profile section provides an opportunity for individuals to share their personal goals, preferences, and needs, ensuring that their care plan is tailored to their unique circumstances.