"People Helping People"

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Forms

  Life Sharing/Program   Life Sharing/Program   General
  Annual Physical &  Physician OTC List   Agency w/Choice (iso) Documentation   Check Request Form
  Annual Physical - Family Living   AWC & Traditional Serv. Timesheet   Check List Form
  Physical forms also require MA-51    MA-51 Form   Master Signature Sheet (med log)   Corrective Action Form
  Annual Practicum Summary   Med Admin Record (MAR) Review   Direct Deposit Form
  A.P.D. Billing Form   Medication Admin Skills Checklist   Emergency Disaster   Consumer Info Form
  Authorization for Service   Medical/Lab/X-Ray Appt. Report  

Employee Address/Phone Change Form

  Blood Sugar Level/Insulin   Medication Log (Life Sharing Only)   Employee Disciplinary Form
  Bumps and Bruises Log   Medication Schedule   Employee Physical Evaluation
  Client Finance - LS   Monitoring Checklist   Employee Status Notice
  Client Finance - Group Home   Monthly Calendar   Event Record
  Counseling Appt Report   Monthly Calendar Word Doc.   FMLA Request Form
  Dental Appointment Form   Occupational Injury or Disease Report   Inventory & Dispersal List
  2 1/2 Minute Fire Drill   PRN/OTC - Medication Form   Mileage Log
  4 1/2 Minute Fire Drill   Psychiatric Meds Review Report   Program Specialist Weekly Schedule
  Face Sheet   Rep Payee Check Request   Request for Leave Form
  Family Aid Sheet   Reconciliation Form   Travel Advance Request
  Life Sharing Fire Drill   Residential Records   Travel Expense Voucher
  Life Sharing Fire Sys. Ck.   Respite Agency w/Choice (iso) Billing   Training Sign in Sheet
  LS Fire Safety FLA#14   Seizure Form    
  LS Fire Safety Word Doc.  

Service Rendered Form

  PA Clearance Forms
  Fire Safety Training Log Doc   Transportation Authorization Form   Child Abuse
  Incident Report Form   Weekly Sub Tracking Form   Criminal History Check
  Incoming & Discontinued Meds   Weekly Count for Self-Medicating    
  Individual Rights Form FLA-42   Work Order Form    
           
         

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

 

 

      

 

 

 

 

 

 

 

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