Provider Forms and Documents

HPC Documentation Monthly (pdf) (Word)

HPC Documentation Weekly (pdf) (Word)

HPC Transportation Individual Mileage Log (pdf) (Word)

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

NMT (Per Trip) w Daily Inspection (pdf)  (Word)

NMT (Per Mile) w Daily Inspection (pdf) (Word)

Ohio Shared Living Documentation Weekly (pdf) (Word)

Ohio Shared Living Documentation Monthly (pdf) (Word)

Waiver Nursing Care Documentation (pdf) (Word)

Agency QA Review Form (pdf) (Word)

Incident Report Form 

Seizure Observation-First Aid Treatment Record

UI Log

 

Click here for Ohio DoDD COVID-19 Resources and Support (Website)

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-19         Covid19 ab comptest           Covid19 ab         My Day Program Closed        Germs-Social-Story          What is Social Distancing Social Story         Social Story About Social Distancing with Pecs          Wash-Your-Hands-Steps 8×11-1          Non-handshake Greetings Social Story         I-Can-Wear-a-Mask-Social-Story         Cloth Mask Elastic            Cloth Mask Ribbon           Surgical Mask       Wearing a Face Mask Social Story-Adult Version         Wearing a Face Mask Social Story-Child Version           Surgical Mask         Telemedicine Social Story