Form DDP-1 PDF Details

In an evolving landscape where the administration and management of programs services for individuals with developmental disabilities remain paramount, the Developmental Disabilities Profile Registration/Movement Form, known colloquially as the DDP-1, emerges as a critical tool. This form is meticulously designed to collect essential demographic, residential, and programmatic information for individuals receiving services under the umbrella of agencies certified or funded by the Office for People With Developmental Disabilities (OPWDD). Mandating completion of specific items such as demographic data, the individual's name, sex, date of birth, and county of residence, the DDP-1 ensures that vital information is systematically recorded and updated. Moreover, it encompasses a broad spectrum of purposes including changes in demographic data, additions, removals, transfers within the agency, out-of-state moves, and death notifications. Program codes, an eight-digit number crucial for program identification within the TABS system, along with preferred communication methods and officially documented disabilities, stand out as indispensable elements in aligning individuals with the most appropriate and responsive services. Through the structured completion of items 1-7 and 18 by agency staff, the DDP-1 form acts as a linchpin in the overarching goal of delivering tailored and efficacious services to those with developmental disabilities, ensuring their needs are met with precision and understanding.

QuestionAnswer
Form NameForm DDP-1
Form Length1 pages
Fillable?Yes
Fillable fields24
Avg. time to fill out5 min 7 sec
Other namesprader, Neurofibromatosis, DDP, ddp1

Form Preview Example

DDP-1 (7/10)

DEVELOPMENTAL DISABILITIES PROFILE

REGISTRATION / MOVEMENT FORM

Fill out items 1 through 7, and 18 including “completed by” and “phone number” on every DDP-1. Complete other items as required.

1

PURPOSE:

1

Demographic Data Change

3

Moved Out of State

5 Died

2

Add

4

Remove

6 Transferred within agency

 

 

2TABS ID: (if known)

3

PERSON’S

LAST

 

 

 

 

FIRST

MI

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

SEX:

1 MALE

2 FEMALE

5

DATE OF

MO

DAY

YR

BIRTH:

 

 

 

 

 

 

 

 

 

6

COUNTY OF

 

 

 

 

 

 

 

RESIDENCE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

REMOVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

ADD

 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM CODE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM CODE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

 

DATE:REMOVE / ADD

 

 

MO

 

DAY

 

 

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

 

 

RESIDENTIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(please print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE

 

 

ZIP

 

12INDIVIDUAL’S RESIDENCE TYPE: (mark only one)

 

1

Alone

4

Department of Social Services

7

OPWDD / Agency Operated Residence

 

 

 

 

 

 

 

 

 

Residence or Foster Care Home

 

 

 

 

 

 

 

 

 

 

 

2

With Friends / Housemates

5

Nursing Facility

 

8

Other (specify)

 

3 With Member of His / Her Own Family

6

Homeless or Shelter

 

 

__________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

SOCIAL SECURITY

 

 

 

 

 

 

 

 

 

14

PERSON’S MEDICAID

 

 

 

 

 

 

 

 

NUMBER:

 

 

 

 

 

 

 

 

 

NUMBER (CIN):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15ETHNICITY / RACE:

1

White

3

Hispanic

5

American Indian / Alaskan

2

Black

4

Asian or Pacific Islander

6

Other

16DISABILITIES: Indicate “1” for Primary (mark only one) and “2” for All Other Disabilities: (mark as many as apply)

___ 1 Developmental Delay

___

8 Psychiatric Disability

___ 15 Fetal Alcohol Syndrome

___ 2 Mental Retardation

___

9 Chronic Physical / Medical

___ 16 Narcolepsy

___ 3 Autism

 

 

Condition

___ 17

Neurofibromatosis

___ 4

Cerebral Palsy

___ 10

Sensory Impairment

___ 18 (Code Not Valid at this Time)

___ 5 Epilepsy / Seizure Disorder

___ 11 Undetermined

___ 19

Spina Bifida

___ 6

Learning Disability

___ 12

Other (specify)________________

___ 20

Tourette Syndrome

___ 7

Other Neurological

___ 13

Traumatic Brain Injury (TBI)

___ 21

Toxic Substance Exposure

 

Impairment

___ 14 Prader-Willi Syndrome (PWS)

___ 22 Child Under 5 Unable to Diagnose

17PREFERRED LANGUAGE:

 

 

 

Spoken

 

 

Nonverbal

 

 

 

 

 

 

 

Understood

1

English

1

Sign

 

 

 

 

 

 

 

1

English

2

Spanish

2

Other Symbolic

 

2

Spanish

 

 

 

97 None

 

 

97 None

 

 

 

 

 

 

 

97 None

98

Other________________________

98

Other________________________

98

Other________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO

 

 

DAY

 

YR

 

 

 

 

 

 

 

18

 

 

 

 

 

 

 

 

DATE COMPLETED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETED BY: (Print staff name)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)__________ ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The DDP-1 is to be completed by all voluntary agency OPWDD-certified or funded programs or services.

Private schools may use either form DDP-1 or OMR 725.

GENERAL INSTRUCTIONS:

Items 1-7 and 18 should always be completed.

Complete items 8 and 10 if a person is leaving a program or 9 and 10 if a person is entering a program. Complete items 8, 9 and 10 if purpose #6, Transferred within agency, is marked.

Complete items 11-17 for anyone new to your agency, for anyone not previously registered in TABS, or if there is a question about whether a person has been previously registered in TABS.

1. Purpose:

1Select this response if information on a previous form should be updated or corrected.

2A person is added to a residence on the first day he/she sleeps in the residence. A person is added to a day program/service on the first day he/she receives services.

4If a person is leaving more than one program within the agency, each program must report the removal of that person from its rolls.

5The date of the person’s death should be entered in item 10, Remove/Add Date.

6Select this response if a person is changing programs (such as a residence) within the same agency. Complete items 8, 9 and 10 if this purpose is chosen.

2.TABS ID:

The minimum information required to register a person in TABS is the person’s name, sex, date of birth, and county of residence. This number may be up to 6 digits in length.

3. Name and 5. Date of Birth:

For each of these items, use the person’s birth certificate as the preferred source of the information. If not available, use the information as it appears on the person’s Medicaid card.

6. County of Residence:

This is the name of the county where the person resides. If adding this person to a residential program, use the name of the county where the residence is located.

8.& 9. Program Code (Remove & Add):

The Program code is an eight (8) digit number used to identify the program or service in TABS. Please contact the DDP Coordinator in your area if you are unsure of the correct code to use.

10. Remove/Add Date:

Enter the date of the event for choice 2-6 in item 1, Purpose. Enter a date if choice 1, Demographic Data Change, involves a change of address.

16. Disabilities:

Any disability indicated in this item should be officially documented in the person’s record including the signature of the diagnosing physician or psychologist.

17. Preferred Language:

Indicate which method of communication the person prefers to use.

18. Completed by:

This should contain the name and phone number (including area code) of the staff person who has completed this form. Please do not ask a parent, guardian or friend to complete the DDP-1.

If you have other questions about any item on the DDP-1, please consult the Users Guide.

Copies of the Guide may be obtained from your DDP Coordinator.

How to Edit Form DDP-1 Online for Free

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Concentrate while completing this form. Make sure that each and every blank field is filled in correctly.

1. It is important to complete the prader accurately, hence be attentive while filling out the segments containing these fields:

Part no. 1 for filling in CIN

2. Once your current task is complete, take the next step – fill out all of these fields - Residence or Foster Care Home, With Member of His Her Own Family, With Friends Housemates, SOCIAL SECURITY NUMBER ECAR, Nursing Facility, Other specify, Homeless or Shelter, PERSONS MEDICAID NUMBER CIN, White, Black, Hispanic, American Indian Alaskan, Asian or Pacific Islander, Other, and DISABILITIES Indicate for Primary with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

CIN conclusion process shown (stage 2)

As for White and Black, make sure you double-check them in this section. Both these are the most significant ones in this file.

3. In this particular stage, take a look at Other, Other, Other, DATE COMPLETED, DAY, COMPLETED BY Print staff name, and PHONE NUMBER. Each of these are required to be filled out with highest focus on detail.

Writing part 3 in CIN

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