Clemens Health | HCBS provider comparison sheet
Updated 2026-10-05 | (651) 354-1196

Download this editable worksheet, add your notes, and bring it to the relevant planning conversation. Leave unknown details blank and identify who can confirm them.

Shared request
What service, area, schedule and priorities were given to every provider?
Your notes: ________________________________________

Provider identity
Which organization and contact are you speaking with, and what record did you check?
Your notes: ________________________________________

Service and schedule fit
What is confirmed, unavailable or still under review?
Your notes: ________________________________________

Person’s preferences
How does the provider explain communication, worker fit and concerns?
Your notes: ________________________________________

Next confirmation
Which unanswered question could change the decision, and who will answer it?
Your notes: ________________________________________

Illustrative example
A person prefers afternoon visits and wants to participate in introductions. One provider confirms the introduction process but has not checked afternoons. The family keeps those answers separate rather than describing the provider as a complete match.

Next step
Use the same questions when contacting Clemens Health. Share the priorities that matter to the person and ask which details can be confirmed for their specific request.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.