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CDC+ Consultant Forms

These forms are for the sole use of the consultant.

Document Description
Steps to Becoming a Consultant Tells you everything you need to know to become a consultant for CDC+.
Provider Enrollment Cover Sheet
This form is the cover sheet for the package you must complete to become authorized by Medicaid to provide consultant services and to be added to the CDC+ Consultant Registry so you can be selected by CDC+ participants to be their consultant.
Consultant Memorandum of Agreement The Memorandum of Agreement is a written agreement between the APD area office and each consultant or consultant agency. The agreement sets forth the responsibilities of the consultant or consultant agency for the CDC+ Program.
Consultant Registration Form - Solo Practitioner Use this registration form if you are a solo practitioner. If you work for an agency and are the only WSC with that agency who is also a consultant, you must register as a solo practitioner. When a second WSC completes consultant training and registers as a consultant, you complete a Consultant Registration Update form and change from solo to agency-affiliated.
Consultant Registration Form - Agency Affiliated Use this registration form if you work for an agency.
Agency Registration Each agency with 2 or more WSCs who are registered as CDC+ consultants must register as an agency for consultant services.
Consultant Registration Update Form Use this form to change any information on your original registration form.
Agency Registration Update Form Use this form to change any information on the original registration form
CDC+ Participant Review Form Complete this form each month to document your required monthly contacts with your CDC+ Participants or their Representatives.
CDC+ Application Enrollment Process Use these procedures when submitting an Application and Enrollment Packet for New Starts.
Participant Information Update form Complete this form for updates to participant information.