Brighter, Stronger Foundation - Autism Waiver Plan of Care Submission Form

To streamline communication, improve tracking, and ensure timely processing, please submit all Plan of Care documents using this Google Form.

Please do not submit Plans of Cares via email. Submissions sent by email may be returned and redirected to this form to ensure proper documentation and workflow management.

Please complete all required fields and upload the Plan of Care document prior to submission. Once submitted, the form will automatically route the information to the appropriate team members for review.

Thank you for your cooperation and partnership as we implement this updated process.

Email address *

Service Coordinator Name *

County/Jurisdiction: *

Client Name: *

POC Number: *

POC Includes: *

Adding a Service

Terminating a Service

Transferring a Service

Splitting a Service Between Providers

Updating Service Hours

Continuation of Current Services

Additional Comments:

Please Upload Client's Plan of Care