Business Records Book:
- Business Records Book Cover Sheet (12.87 KB)
- Business Records Table of Contents (116.99 KB)
- Caregiver Employment Notification updated 8.1.2017 (127.93 KB)
- Caregiver Qualifications and Training Log (optional) (34.34 KB)
- Caregiver Checklist (102.26 KB)
- Caregiver Workbook Certificate (72.97 KB)
- Fax Cover Sheet (optional) (60.25 KB)
- Operator Visiting Log (Optional) (122.26 KB)
- Staffing Plan (170.33 KB)
- Staffing Plan Excel Form (10.77 KB)
- Menu Template (742.59 KB)
- Emergency Phone List (11.65 KB)
- Fire/Evacuation Drill Record updated 4-12-2017 (82.91 KB)
- Backup Operator (145.54 KB)
- Smoke Alarm & Carbon Monoxide Detector Monthly Test Log (299.36 KB)
- Emergency Preparedness Plan updated 11.6.2017 (486.8 KB)
Resident Records Books:
- Resident Records Books Cover Sheet (570.76 KB)
- Resident Records Table of Contents - DD (117.22 KB)
- Resident Records Table of Contents - APD and MHA (116.35 KB)
- Residency Agreement (245.73 KB)
- Sample - Elderplace Residency Agreement (90.06 KB)
- Sample Private Pay Residency Agreement (289.29 KB)
- Classification Worksheet (171.32 KB)
- ADL Definitions (105.2 KB)
- APD and MHA Resident Screening Sheet updated 8-24-2020 (237.79 KB)
- IDD Resident Screening Sheet (457.82 KB)
- Resident Rescreening Form updated 5-30-19 (160.42 KB)
- Resident Information Sheet (147.86 KB)
- Long Term Care Assessment Notice (94.36 KB)
- Resident Personal Possessions Inventory (126.77 KB)
- Resident's Bill of Rights (effective July 1, 2017) (mandatory form) (93.55 KB)
- Notice of Involuntary Move (197.81 KB)
- Activity Log (249.39 KB)
- Mental Health Plan of Care 4/18/12 (113 KB)
- APD-MHA Care Plan - older format (238.85 KB)
- APD-MHA Care Plan updated 5-4-2017 (1 MB)
- Commonly Used Abbreviations (15.36 KB)
- Recommended Day Care Relative Care Request Form (20.94 KB)
- Weekly Progress Notes (176.52 KB)
- Incident Report Form (280.56 KB)
- Individual Financial Record (110.4 KB)
- Authorization to release confidential information (11.92 KB)
- RN or Physician Monitoring Checklist (111.76 KB)
Medication Administration Records:
- Cover Sheet for MAR Book (37.51 KB)
- Table of Contents For MAR Book (104.75 KB)
- MAR-PRN Form (193.76 KB)
- Physician order form updated 3.27.2018 (103.97 KB)
- PRN Guideline (102.3 KB)
- Controlled Substance Count Sheet (428.83 KB)
- Medication Disposal Record Form (133.1 KB)
- Commonly Used Medical Abbreviations (97.41 KB)
- Balancing Test for I/DD (279.18 KB)
- MAR Book - Packet of All Forms (906.11 KB)
- DEA Controlled Substances List (356.7 KB)
