MOLST Legal Requirements Checklist For People With ...
If the 1750-b surrogate has requested that artificially provided nutrition or hydration be hdrawit wn or withheld, one of the following additional factors must also be met: _____ a. there is no reasonable hope of maintaining fe (expli lain_____
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opwdd.ny.govWhen individual has selected multiple providers for this service, list additional agency names here: Justification. for service and description of how it supports the individual’s goals (please provide specific details): Additional Information that may be useful to the DDRO in consideration of this service request (optional):
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DO NOT HANDWRITE IN SECTION 1DO NOT HANDWRITE IN …
opwdd.ny.govJan 28, 2019 · Submit the completed form to the appropriate unit listed at the bottom of the form; do not submit this page. Do NOT submit to the wrong unit or multiple units. Instructions for Form IMS-01 (Revised 01/28/2019)Part 3 - Select ONE application from the second drop down menu Select application needed.
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opwdd.ny.govServices, Prevocational Services and Pathway to Employment are available only as Direct Provider Purchased Services. Self‐Direction Guidance for Providers April 6, 2020 Page 12 ...
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