Before filling out packets and forms, it is important to know your role. Click here or scroll to the bottom of the page to review the different roles to help you determine which forms you need to fill out.
Sentara Health Plans Forms
Spanish
Enrollment Packets
Employer of Record (EOR) Enrollment
The Employer Enrollment Packet contains all the required forms to set up an individual as the Employer.
Electronic Employer Enrollment Packet – Spanish (recommended – fastest way to enroll)
Printable Employer Enrollment Packet – Spanish (slowest way to enroll)
Attendant Enrollment
The Attendant Enrollment Packet contains all the required forms to begin the employment process.
Electronic Attendant Enrollment Packet (recommended – fastest way to enroll and get paid)
Printable Attendant Enrollment Packet (slowest way to enroll)
Fiscal Agent Request Form (FARF)
This form is for Service Facilitators.
Form/Packet Instructional Materials
Form/Packet Instructional Materials
Video: Employer Enrollment Packet Instructions
Video: Attendant Enrollment Packet Instructions
Employer Enrollment Packet Instructions – Spanish
Attendant Enrollment Packet Instructions
Secure Email Instructions – Spanish
Wisely Pay Card Instructions – Spanish
Change of Employer of Record
Change of Employer of Record Forms (Consumer and Attendant Remain the Same)
New Employer must submit to Consumer Direct Care Network (1) an Employer Enrollment Packet and (2) an Employer of Record Change Attendant Attestation Form for each employed Attendant.
Employer of Record Change Attendant Attestation Form
Electronic Employer Enrollment Packet – Spanish (recommended – fastest way to enroll)
Printable Employer Enrollment Packet – Spanish (slowest way to enroll)
Payroll, Exemptions, and Other Forms
What’s My Role?
Before filling out packets and forms, it is important to know your role. Below are definitions to help you determine which forms you need to fill out.
Employer of Record (EOR) – The Employer of Record (EOR) is the person who performs the function of the employer in the consumer-directed model. The EOR may be the individual receiving the services or another person designated by the individual. If you are the Employer of Record, you will fill out the Employer packets and/or forms.
Attendant – The person hired to provide consumer directed care or supports. This person is sometimes called a Caregiver. If you are the Attendant, you will fill out the Attendant packets and/or forms.
Service Facilitator – A person who helps Participants and their family. If you are the Service Facilitator, you will fill out the Fiscal Agent Request Form (FARF).
Participant – The person receiving Medicaid waiver services/supports. This person is also called an Individual. If you are the Participant and are your own Employer of Record, you will fill out the Employer packets and/or forms.