Service Coordinators for the Home and Community Based Medicaid
Waiver make referrals to ATP for assistive technology and home modifications.
Please note: all forms found on this page are to be used
by Authorized Service Coordinators only.
Forms
Referral Form
- PDF(544 KB)Please note: This form was made fillable
for print purposes only. This form can be completed and printed
online; however, this form cannot be submitted electronically, and
any information you add to this form cannot be saved to your hard
drive.
