Blank Forms


Admission and Discharge Register Form
Equal Opportunity Employer Applicant Flow Survey
HCBS Service Recipient Rights Restrictions
Individual Record Compliance Review
Maltreatment Report Status Form
Non-Drive Agreement
Personal Information on New Employees
Person Centered Planning and Service Delivery Requirements
Pet Approval Form
Release of Information
Report of Suspected Abuse or Neglect
Service Suspension or Termination Checklist
Service Admission Checklist
Service Recipient Record Checklist
Support Team Meeting Summary Annual
Support Team Meeting Short Form
Volunteer Program Packet

Daily Documentation

Behavior Tracking

Behavior Monitor
Bubble Sheet (Rehabilitation Tracking - Residential)
Monthly Data Summary pg1
Monthly Data Summary pg2
Monthly Data Summary pg3
Rehabilitation Tracking Summary
Target Behavior Tracking Summary
Token Tracking

Community Documentation

Community Client Time Log
Community Participation Record
Independence Sign-out Sheet
Waiver Transportation Log

Day Program Documentation

Adult Day IAPP
ADC Individual Needs Assessment
ADC Individual Service Plan
Adult Day Consent Packet
Day Program Application
Day Program Admission Form
Meeting Minutes - DP
Client Course Evaluation
Client Profile
Day Program Quarterly Report
Day Program Token Tracking
Health Services Record
ILS - Consents
ILS Bus Station Training
ILS City Bus Training
ILS Grocery Store
Day Programming Rehab Tracking
Day Programming Group and Activity Tracking

Supported Employment Service Documents

Consent Packet - SES
Rehabilitation Tracking - SES
Supports and Outcomes - SES
Evaluation of Outcomes - SES
Service Recipient Time Log - SES
Paper Time Card - SES
Self-Management Assessment - SES

Customized Living Service Documents

Consent Packet - CL
Policy Acknowledgement Signature Page - CL

Financial Documentation

Blank Receipts
Cash Resource Record

House Forms

Blank Timecard
Cleaning Checklist
Cleaning Supply Order Form
Client Telephone Record
Condiment Order Form
Deep Clean Evaluation
Fire Drill Tracking
First Aid Inventory
Grievance Form
Home Trip Form
House Telephone Record
Job Order Request
Monthly Cleaning
Overnight Client Checks
Paper Products Order Form
PTO Donation Form
Punch Discrepancy
Refrigerator Temperature Log
Tornado Drill Tracking
Vehicle Integrity Check
Staff Assignment Sheet
Training Acknowledgement - Individual Service Recipient
Training Acknowledgement - PAPP
WalMart Order Form


Employee Accident Report
Behavioral Intervention Report Form
Emergency Report and Internal Review
Hazard Report
Illness / Injury Report
Incident Report and Internal Review
Vehicle Accident Report

Employee Documents

Documentation Expectations Acknowledgement
Leave of Absence Request
PTO Cashout Request
Vacation Request
Pet Approval Form


Appointment Sheet
Client Weight Record (generic) 
Client Weights Female
Client Weights Male
Fluid Intake
Fluid Output Record
Grooming and Hygiene Tracking
Home Visit Medication Setup
Medication Administration Record (blank)
Medication Administration Review Record
Medication Error Report Form
Medication Administration Check Off
Medication Independence Distribution
Physician's Report
PRN Inventory
Psychotropic Medication Use and Monitoring Record
Psychotropic Medication Monitoring for Non-Psychotropic Medication
Seizure Diary

Supervisor Forms and Templates

245D Licensing Resources
90 Day Review
10 Day Approval Page
Client Picture Information Sheet
Crisis Debriefing
CRS Licensing Checklist
Death Report
Discharge Checklist
Discharge Confirmation
Discharge Memo
Disciplinary Warning
Fill-in Info House
House Inspection Evaluation
Licensing Safety Checklist
New Client Needs Checklist
Outcome Evaluation Pre-Planning Checklist
Performance Evaluation
Progress Review (Quarterly Report) Template
Employee Orientation Training Record
Employee Annual Training Record
Supervisor Safety Checklist
Supervisor Task Checklist
Self Management Assessment - Residential
Service Recipient Training Log
Program Abuse Prevention Plan Training Log
Supports and Outcomes Template
TBI Header
Team Meeting Values Review
Designated Coordinator QA Tool

File Tabs & Indexes

Day Program Back File Index
Day Program Book Index
Documentation Book Index
Documentation, Master & DP Book Tabs
DP Back File Tabs
Master Book Index
Residential Back File Index
Residential Back File Tabs