The purpose of the basic agreement is to show that you and your service coordinator have agreed to work together. It should be updated at least every six months or if there are any changes to the agreement.

The basic agreement is a double-sided document. We will describe both sides here from top to bottom. The form is on the next two pages.

The first section of this form indicates who you picked to be your service coordinator.

The second section, titled Service Coordination Information, gives you, your service coordinator's name, number, and hours of work. It gives you an emergency phone number if you need to get a hold of someone after work hours. It also gives you the name and number of your service coordinator's supervisor.

The third section, titled Responsibilities of the Service Coordinator or Service Coordination Vendor, covers two things. It is the only place that states how many times, you and your service coordinator have agreed to meet each month. The section describes how your service coordinator will work with you.

Along with this, it describes choices you have in changing your service coordinator or the agency (vendor) providing you service coordination and how your service coordinator will assist you in making the changes you've requested.

The next section, titled Responsibilities of the Person Receiving Medicaid Service Coordination, talks about how you will work with your service coordinator. The last section is a signature section.