Provider Forms and Documents

 

HPC Documentation Monthly 01.2022 (pdf)    (Word)

HPC Documentation Weekly 01.2022 (pdf)     (Word)

HPC Transportation Individual Mileage Log 01.2022 (pdf)    (Word)

HPC Transportation Multiple Person Mileage Log 01.2022 (pdf)    (Word)

IES Documentation 01.2022 (pdf)    (Word)

Informal Respite Documentation 01.2022 (pdf)    (Word)

Invoice for Local Funds as Last Resort (pdf)

NMT (Per Mile) 01.2022 (pdf)    (Word)

NMT (Per Trip) 01.2022 (pdf)    (Word)

NMT Daily Inspection Checklist 01.2022 (pdf)    (Word)

Ohio Shared Living Documentation Monthly 01.2022 (pdf)    (Word)

Ohio Shared Living Documentation Weekly 01.2022 (pdf)    (Word)

Waiver Nursing Care Documentation 01.2022 (pdf)    (Word)

Seizure Observation-First Aid Treatment Record

Incident Report Form (pdf)

UIR log (pdf)

MUI Annual Review-Independent

Agency QA Review Form (pdf)     (Word)

 

 

Educational COVID-19 Training Materials for ADS/ VH/ STEPS/ HPC:

Here are a variety of educational resources DSP’s can utilize with Individuals served to assist in increasing their knowledge and abilities of the COVID-9 Pandemic.  The resources include social stories, printable PEC’s for donning and doffing masks and other helpful tools.
What is the Coronavirus Social Story  Plain Language Information on COVID-19Covid19 ab comptestCovid19 abMy Day Program ClosedGerms-Social-StoryWhat is Social Distancing Social StorySocial Story About Social Distancing with PecsWash-Your-Hands-Steps 8×11-1Non-handshake Greetings Social StoryI-Can-Wear-a-Mask-Social-StoryCloth Mask ElasticCloth Mask RibbonSurgical MaskWearing a Face Mask Social Story-Adult VersionWearing a Face Mask Social Story-Child VersionSurgical MaskTelemedicine Social Story