Business Records Book
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Business Records Book Cover Sheet
(12.87 KB)
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Business Records Table of Contents
(116.99 KB)
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Caregiver Employment Notification
(82.3 KB)
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Caregiver Checklist
(96.83 KB)
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Caregiver Workbook Certificate
(72.97 KB)
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Fax Cover Sheet (optional)
(60.25 KB)
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Operator Visiting Log (Optional)
(122.26 KB)
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Staffing Plan
(170.33 KB)
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Staffing Plan Excel Form
(10.77 KB)
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Menu Template
(742.59 KB)
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Emergency Phone List
(11.65 KB)
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Backup Operator
(102.94 KB)
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Emergency Preparedness Plan
(644.44 KB)
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Adult Care Home Relocation Form
(265.54 KB)
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Opioid Overdose Daily Checks Monthly Log
(168.28 KB)
Resident Records Books
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Resident Records Books Cover Sheet
(570.76 KB)
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Resident Records Table of Contents - APD and MHA
(116.35 KB)
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Residency Agreement Sample Medicaid
(457.58 KB)
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Residency Agreement Sample ElderPlace
(456.99 KB)
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Residency Agreement Sample Private Pay
(683.02 KB)
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Classification Worksheet
(171.32 KB)
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ADL Definitions
(105.2 KB)
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APD and MHA Resident Screening Sheet
(260.6 KB)
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Resident Re-Screening Sheet
(112.88 KB)
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Resident Information Sheet
(113.21 KB)
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Long Term Care Assessment Notice
(94.36 KB)
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Resident Personal Possessions Inventory
(126.77 KB)
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Residents' Bill of Rights
(99.94 KB)
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Nondiscrimination Policy
(55.11 KB)
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APD Resident Bed Rail Acknowledgment
(49.64 KB)
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Private-pay residents only:
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Notice of Involuntary Move
(197.81 KB)
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Activity Log
(249.39 KB)
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Mental Health Plan of Care 4/18/12
(113 KB)
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APD-MHA Care Plan - older format
(238.85 KB)
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Commonly Used Abbreviations
(15.36 KB)
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Weekly Progress Notes
(176.52 KB)
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Incident Report
(338.02 KB)
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Individual Financial Record
(110.4 KB)
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RN or Physician Monitoring Checklist
(111.76 KB)
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Medication Administration Records
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Cover Sheet for MAR Book
(37.51 KB)
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Table of Contents For MAR Book
(104.75 KB)
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MAR-PRN Form
(193.76 KB)
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Physician order form updated 3.27.2018
(103.97 KB)
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PRN Guideline
(102.3 KB)
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Controlled Substance Count Sheet
(428.83 KB)
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Medication Disposal Record Form
(133.1 KB)
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Commonly Used Medical Abbreviations
(97.41 KB)
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MAR Book - Packet of All Forms
(906.11 KB)
Exception Requests
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Exception Request General
(74.39 KB)
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Exception Request for Out Of Class Resident
(92.68 KB)
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Request for More than One Bedbound Resident
(89.12 KB)
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Interagency Placement Exception Request
(398.1 KB)
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Exception Request Ramps
(98.04 KB)
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Exception Request to 72 inch rule
(98.36 KB)
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Vacation or Absence From Home Request
(337.47 KB)
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Resident Manager Exception Request
(207.57 KB)
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Shift Managers Exception Request
(96.14 KB)
Operator and Resident Manager Forms
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Provider Enrollment Agreement
(260.82 KB)
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Real Estate Form
(117.83 KB)
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Proposed Operating Budget
(812.42 KB)
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Professional Character Reference
(391.35 KB)
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Resident Manager Change Request
(103.96 KB)
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Sample Job Application
(126.13 KB)
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APD and BH Self Audit Tool
(1.2 MB)
Reclassification Request
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APD Level 3 Reclassification Request
(142.16 KB)
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APD Class 3 Medical Professional Reference
(72.05 KB)
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APD or MHA Class 2 Reclassification Request
(144.01 KB)
Electronic Software for Record Keeping
An exception is needed to use electronic software for record keeping. All software must be approved by the ACHP. These software have been screened to meet ACHP criteria:
If you are interested in using a different software, it must be reviewed and approved by ACHP prior to use.