Population Specific Paperwork

For clients that take medications in our services
☐ Authorization for Over-The Counter (OTC) medications
signed annually by the physician
☐ Authorization to Self-Administer Medication
updated with new prescriptions AND
signed annually by the physician
☐ Medication Education
provided by the physician annually AND
before new medication begins

For Residential Services
☐ Client Funds in Residential Services Policy
Procedure: Given at the start of services in the Welcome Packet

☐“What are my Rights in a 24-hour Facility?”  Disability Rights NC Brochure
Procedure: Given at the start of services in the Welcome Packet
☐ Protection of Client Possessions Policy
Procedure: Given at the start of services in the Welcome Packet

☐ 4.13 Provider Owned or Controlled Residential Settings Resident Agreement            created 12/1/2015
Procedure: to be completed at the beginning of service and annually there after

☐ 4.14 Client Key to Residence created 12/1/2015
Procedure: Given at the start of services in the Welcome Packet

For Non-Residential Services
☐ Field Trip Permission Form

For clients in DHSR licensed services
☐ Receipt of No Smoking Notice

Programs/Services Paperwork

AFL – Innovations Residential Supports
☐ Handbook
☐ Program/Service Description

Alamance House – Level III child MH
☐ Affidavit of Student in Good Standing
☐ Approved Therapeutic Leave
☐ Handbook
☐ Program/Service Description

Alberta Care – Innovations Day Supports
☐ Field Trip Permission Form
☐ Handbook
☐ Program/Service Description

Autumn House – Innovations Residential Supports
☐ Handbook
☐ Program/Service Description

Booth Road Group Home – Group Living Low Adult MH
☐ Handbook
☐ Program/Service Description

Community Guide – Innovations
☐ Handbook PDF
☐ Handbook Word
☐ Program/Service Description

Homestead Place Group Home – Group Living High Adult MH
☐ Handbook
☐ Program/Service Description

New Directions – Innovations Day Support
☐ Handbook
☐ Program/Service Description

Periodic Services – Innovations
☐ Handbook
☐ Community Networking Description
☐ Respite Description
☐ Personal Care/Enhanced Personal Care Description
☐ In-Home Skill Building Description

Specialized Consultative Services – Innovations
☐ Handbook
☐ Program/Service Description

Supported Employment – Innovations
☐ Handbook (see handbooks for day programs)
☐ Program/Service Description

Therapeutic Foster Care
http://info.dhhs.state.nc.us/olm/forms/forms.aspx?dc=dss
☐ Handbook
☐ Program/Service Description

 

Please use the comment box below to let me know how this works for your program. Thanks! Jenny