Please complete the following application for AIM’s Recreation program.
Before you begin, please be sure to have the following information ready:
- Emergency contact information
- Medicaid number
- Other Insurance information (if applicable)
- Diagnosis, allergies and medications
- Care Manager contact information
- Self Direction Support Broker and Fiscal Intermediary contact information (if applicable)
- Participants interests and fears
- Participants medical or dietary precautions, and adaptive equipment needs (including for transportation)
Please contact your Care Manager and have them submit the following paperwork to AMarion@aimservicesinc.org:
- 2 most current Life Plans
- Service Authorization (NOD.9)
- HCBS Waiver (NOD.1)
- OPWDD Determination of Eligibility
- Current Level of Care Eligibility of Determination (LCED)
- Consent/Authorization Forms Signed or Declined
Please note, once your application and paperwork is received, the participant will begin Recreation on a trial basis.
If you have any questions, please contact Audrey Marion at AMarion@aimservicesinc.org