REVISED: 09/25/09 - Thomas Allen Inc



CODEDESCRIPTIONFULL CODEPER2660 DAY EMPLOYEE FEEDBACK TOOLPER/26-914SR1406ACCOUNTING FOR DISCLOSURESSR/1406-1003PER40-1ACKNOWLEDGEMENT OF RULE 1PER/40.1-497SO941ACTIVE LEISURE PARTICIPATIONSO/941-706PER40.8ADL/IADL COMPETENCY ASSESSMENTPER/40.8-215SO944ACTIVITY LOGGINGSSO/944-505PER8AD REQUESTPER/8-610SR1508ADAPTIVE EQUIPMENT MONITORING TOOLSR/1508-707CM1021ADMINISTRATIVE REVIEW FOR CHILD IN PLCMNTCM/1021-1297ICF102ADMISSION COMMITTEE PLACEMENT DECISIONICF/102-0290CM106-1ADMISSION, DISCHARGE AND STATUS CHANGE CM/106.1-414 CM106-2ADMISSION, DISCHARGE AND STATUS CHANGE (CARE COORDINATION)CM/106.2-615 PER63AFFIRMATIVE ACTION DATA INPUT SHEETPER/63-1098 PER10AFFIRMATIVE ACTION QUESTIONNAIREPER10-514ICF105.2AGREEMENT TO PROVIDE CONSULTANT DIETITAN SERVICESICF/105.2-0190ICF105.1AGREEMENT TO PROVIDE DENTAL SERVICESICF/105.1-0190ICF105.14AGREEMENT TO PROVIDE GENERAL MEDICAL SERVICESICF/105.14-0190ICF105.13AGREEMENT TO PROVIDE NEUROLOGICAL SERVICESICF/105.13-0290ICF105.5AGREEMENT TO PROVIDE OPTHAMOLOGY/ OPTOMETRY SERVICESICF/105.5-0990ICF105.7AGREEMENT TO PROVIDE PHYSICAL THERAPY SERVICESICF/105.7-0190ICF105.6AGREEMENT TO PROVIDE PODIATRIST SERVICESICF/105.6-0190ICF105.12AGREEMENT TO PROVIDE PSYCHIATRIC SERVICESICF/105.12-0290ICF105.9AGREEMENT TO PROVIDE PSYCHOLOGICAL SERVICESICF/105.9-0190SR105.3AGREEMENT TO PROVIDE SERVICESSR/105.3-611ICF105.10AGREEMENT TO PROVIDE SPEECH PATHOLOGY AND LANGUAGE SERVICESICF/105.10-0190ICF105.11AGREEMENT TO PROVIDE THERAPY SERVICESICF/105.11-0290SO1305ALCOHOLIC BEVERAGE CONSENT FORMSO/1305-107CONS451-1ANNUAL ACCOUNT – DAKOTA COUNTYCONS/451.1-0105SO454ANNUAL CHECKLIST AND FLOWCHART CSSP ADDENDUM/ANNUAL MEETINGSO/454-1214CONS441.1ANNUAL INFORMATIONAL STATEMENTCONS/441.1-810ICF1010.2ANNUAL SUMMARY OF SKILLS AND NEEDS (ICF/MR ONLY)ICF/1010.2-706CM1463ANOKA COUNTY DATA REQUEST FORMCM/1463-1299 CM505ANOKA COUNTY SOCIAL WELFARE FUND DISBURSEMENT PLANCM/505-1201 PER10APPLICATION QUESTIONNAIREPER/10-708SO1586ARCHIVE REQUESTSO/1586-1005HEN220ASSESSMENT INFORMATION CHECKLISTHEN/220-706SO954ASSESSMENT OF CLIENT INTERESTSSO/954-408PER87ASSESSMENT OF PROPER LIFTING/TRANSFERRING TECHNIQUESPER87-714SR201ASSESSMENT OF STAFF HOYER LIFT TRANSFER TECHNIQUESSR/201-714SR250ASSESSMENT OF STAFF TRANSFER TECHNIQUES USING AN EZ/LIFT-U-UP/GET-U-UP DEVICESR/250-215SR202ASSESSMENT OF STAFF – VAN LIFT OPERATIONS & WHEELCHAIR SECUREMENT TECHNIQUES VAN - SEE ALSO - SAFETY TEST OUT USING Q’STRAINTS (SR1350)SR/202-1114SR1350ASSESSMENT OF VAN LIFT OPERATION AND WHEELCHAIR SECURMENT USING Q’STRAINTS – SEE ALSO - ASSESSMENT OF STAFF – VAN LIFT OPERATIONS & WHEELCHAIR SECUREMENT TECHNIQUES VAN (SR202)SR/1350-1114SR220.1ASSESSMENT SUMMARY – GUIDELINES FOR COMPLETIONSR/220.1-114ICF205.1ATTACHMENT A – PROCEDURES FOR CONTINUED STAY REVIEWICF/205.1-0190OAK205.2ATTACHMENT B MEMBERS OF UTILIZATION REVIEW COMMITTEEOAK/205.2-308 ICF205.3ATTACHMENT C – CONTINUOUS STAY REVIEW CHECKLISTICF/205.3-1290ICF205.4ATTACHMENT D UTILIZATION REVIEW COMMITTEE MINUTESICF/205.4-1000 ICF205.5ATTACHMENT E – LIST OF CASES APPROVED FOR CONTINUED STAYICF/205.5-0190ICF205.6ATTACHMENT FICF/205.6-0190ICF205.7ATTACHMENT G – CONTRACT FOR UTILIZATION REVIEW SERVICEICF/205.7-1090ICF205.8ATTACHMENT H – LEVEL OF CARE CRITERIAICF/205.8-0191ICF205.9ATTACHMENT I – CONTRACT FOR PHYSICIAN UTILIZATION REVIEW SERVICEICF/205.9-0390PER66ATTENDANCE HISTORYPER/66-1100 SO1470AUDIT SCHEDULE 2015SO/1470-215 SR403.1AUTHORIZATIONSR/403.1-403CM403.2AUTHORIZATION FOR THE RELEASE OF INFORMATIONCM/403.2-1112CM403.3AUTHORIZATION FOR THE RELEASE OF INFORMATIONCM/403.3-613SR506AUTHORIZATION TO ASSIST WITH FINANCESSR/506-315 SILS1460AUTHORIZATION TO WORK AT HOME SILS/1460-802 JS848AWAKE NIGHT COUNSELOR TASKSJS/848-1102 PER20.5BACKGROUND STUDY FORMPER/20.5-1112PER20.6BACKGROUND STUDY FORM (INTELLICORP)PER/20.6-1111SO644BASELINE LOGGINGSSO/644-1199 SO315BASELINE ON GAS STOVE SAFETY SKILLSSO/315-0691SR618BASELINE PLANSR/618-1197SR301BEDROOM FURNISHINGSSR/301-115SR1005.10BEHAVIOR INTERVENTION REPORTING FORMSR/1005.10-114SR1005.11BEHAVIOR INTERVENTION REPORT FORM INSTRUCTIONSSR/1005.11-114SO641.2BEHAVIOR OBSERVATION SYSTEM – CLIENT DATA SHEETSO/641.2-0190SO642.09BEHAVIOR RECORDING – ? HOUR INTERVALSSO/642.09-1091SO211BEHAVIORAL ASSESSMENT OF INDEPENDENT LIVING SKILLSSO/211-1299 SR709-5BEHAVIORAL SUPPORT PLAN (BSP) WHEN PSYCHOTROPIC MEDICATION(S) ARE PRESCRIBEDSR/709.5-114SO1370BLANK CALENDAR – LANDSCAPE SO/1370-0889 SO1370.1BLANK CALDENDAR – PORTRAIT SO/1370.1-506PER4BLOODBORNE PATHOGENS SUPPLY REQUESTPER/4-309 PER40.6BLOODBORNE PATHOGEN TESTPER/40.6-909BR850BRYANT HOUSEHOLD MAINTENANCE CHECKLISTBR/850-601 SR1400BUSINESS ASSOCIATE AGREEMENTSR/1400-611CM462CADI & TBI CASE BOOK AUDITCM/462-306 FIN09CALCULATION OF BI-WEEKLY PAYROLL TAX LIABILITIESFIN/09-405CM1131CALENDAR OF MAJOR CLIENT ACTIVITIES - CASE MANAGERS (MR/DD)CM/1131-1197CM1131.1CALENDAR OF MAJOR CLIENT ACTIVITIES - CASE MANAGERS (CADI/TBI) CM/1131.1-1100 SO1180CALENDAR OF MAJOR CLIENT, STAFF OR DIVISION ACTIVITIESSO/1180-307CM1170CASE LOAD REPORTCM/1170-0996CM47CASEMANAGEMENT AND MANAGED CARE COORDINATION REQUEST FOR ONGOING TRAININGCM/47-315CM1041.1CASE MANAGEMENT BILLING SHEET FOR RAMSEY COUNTYCM/1041.1-108CM464CASE MANAGEMENT FILE AUDIT DD (RULE 185)CM/464-212CM465CASE MANAGEMENT CASEBOOK AUDIT (EW)CM/465-306CM463CASE MANAGEMENT CASEBOOK AUDIT (HENNEPIN CADI/TBI)CM/463-306CM462CASE MANAGEMENT CASEBOOK AUDIT (CADI/TBI)CM/462-306CM206CASE MANAGEMENT CLIENT FACE SHEET – CADI/TBI/CACCM/206-1206CM206-1CASE MANAGEMENT CLIENT FACE SHEET CM/206.1-1206CM1020CASE MANAGEMENT SEMI-ANNUAL REPORTSM/1020-504CM450.2CASE MANAGEMENT SERVICES SATISFACTION SURVEYCM/450.2-913PER02CASE MANAGERS STATEMENT OF UNDERSTANDINGPER/02-599 CM520CASE MANAGER’S COST REPORTCM/520-706CM480CASE NOTESCM/480-1001 CM481CASE NOTES GUIDELINESCM/481-805SILS452.1CASE REVIEW SCATTERED SITESSILS/452.1-1014SO1593CHECK REQUESTSO/1593-0398SO581.1CHECKING ACCOUNT RECEIPTSO/581.1-1003SO710CLASSIFICATIONS OF PSYCHOTROPIC MEDICATIONS AS OF 2011SO/710-913SO855CLEANING CHECKLISTSO/855-1099SO855.1CLEANING SCHEDULESO/855.1-1189 SO355CLEAING SUPPLY INVENTORYSO/355-0696CM1340CLIENT CONTACT RECORDCM/1340-1106 SEAS1340CLIENT CONTACT RECORD - SEASSEAS/1340-202 SR540CLIENT FINANCIAL AUDIT REPORTSR/540-108 SO311CLIENT INSERVICESO/311-0490SO641CLIENT LOGGINGSSO/641-505SO1130CLIENT MEETING AND WRITTEN REPORT SCHEDULE SO/1130-114 SO702CLIENT MEDICAL APPOINTMENTSSO/702-1089SR402CLIENT PERSONAL RECORDSR/402-114 SEAS402CLIENT PERSONAL RECORD - SEASSEAS/402-300SR705-1CLIENT PHYSICAL EXAMINATIONSR/705.1-908 SO1172CLIENT SCHEDULESO/1172-0490 SO115CLIENT SIGN OUT SHEETSO/115-1292SO357CLOTHES INVENTORYSO/357-0193CM403CM WASHINGTON COUNTY RELEASE CM/403-111SO1380COMMON ACRONYMSSO/1380-114FC720COMMUNICABLE DISEASE/ILLNESS/INJURY RECORDFC/720-1205SO253COMMUNITY AND STREET SAFETY ASSESSMENTSO/253-0890COMPMNCOMPASS MN BILLING SHEETCompassMN/ - 0105SR404CONSENT FOR PICTURES TO BE USED ON THE INTERNETSR/404-108 SO1310CONSENT FOR VIDEO AND AUDIO RECORDINGSO/1310-0791SR403CONSENT FOR THE RELEASE OF CONFIDENTIAL INFORMATIONSR/403-107SO1000CONSENT TO EXTEND ANNUAL PLANSSO/1000-114CM406CONSUMER SATISFACTION SURVEY - CMCM/406-909 SILS1170CONTACT SCHEDULESILS/1170-411CE101CONTRACT PROCUREMENTCE/101-0891CM460CONTRACT TO ACT AS LEGAL REPRESENTATIVECM/460-1002 CM400CONTRACTED CASE MANAGEMENT SERVICES SURVEY – COUNTY REPRESENTATIVESCM/400-909 SR741CONTROLLED MEDICATIONS ACCOUNTABILITY RECORDSR/741-203SR709CONTROLLED SUBSTANCESSR/709-914SR1010COORDINATED SERVICE AND SUPPORT PLAN ADDENDUM (CSSP-A)SR/1010-1214 SR1010-1CSSP ADDENDUM - GUIDELINES FOR COMPLETIONSR/1010.1-214 SO1571DAILY ACTIVITIES AND TASKSSO/1571-0390CONNECT SERVICES1045DAILY BILLING SHEETCONNECTSERVICES 1045-210CM1598.2DAKOTA COUNTY COVER SHEET CM1598.2-413CONS1040DAKOTA COUNTY SOCIAL SERVICES BILLING STATEMENTCONS/1040-409SR1460DATA PRIVACY/TENNESSEN WARNINGSR/1460-1299 SR1250DAY PROGRAM ATTENDANCESR/1250-1214SR1469DEATH OR SERIOUS INJURY REPORTSR1469-612SO1590DELEGATION COACHING AND MONITORING TOOLSO/1590-407SO703.1DENTAL REFFERAL FORM (OPTIONAL)SO/703.1-908FIN05DETAIL GENERAL LEDGER JOURNAL ENTRIESFIN/05-914SR1469DHS DEATH REPORTSR/1469-103 SR1461DHS VARIANCE REQUESTSR/1461-807CONNECTSERVICES201.1DIAGNOSTIC UPDATECONNECTSERVICES/201.1-210PER8DIRECT CARE POSITION REQUISITIONPER/8-914SR860DISABILTY PARKING CERTIFICATE LETTER EXAMPLESR860-212SR1553DISASTER PREPAREDNESS KIT QUARTERLY CHECKLISTSR/1553-1211PER40.7DISASTER RESPONSE POST-TESTPER/40.7-909ICF126DISCHARGE CHECKLIST – ICF/MRICF/126-907SR126DISCHARGE SUMMARYSR/126-1199 SEAS126DISCHARGE SUMMARY - SEASSEAS/126-202 PER49-4DISCONTINUED EMPLOYMENT NOTIFICATIONPER/49.4-909 SR342 DRILL REPORT - SITE SPECIFIC EMERGENCY PROCEDURESSR/342-414PER90-6DRUG TESTING POLICY MEMOPER/90-6/698 SO642.1DURATION RECORDING DATA SHEETSO/642.1-0591CM706.2EMERGENCY BACK-UP PLANCM/706.2-611SR706EMERGENCY MEDICAL PROCEDURES – PARENTAL/ FAMILY GUARDIANSHIPSR/706-111SR706.1EMERGENCY MEDICAL PROCEDURES – PUBLIC GUARDIANSHIPSR/706.1-603SILS455EMERGENCY PHONE LIST SILS/455-212 OAK390EMERGENCY PHONE NUMBERSOAK/390-815 SO390EMERGENCY PHONE NUMBERSSO/390-815 SR1005-7EMERGENCY USE OF A MANUAL RESTRAINT INCIDENT REPORT SR/1005.7-214PER81.1 EMPLOYEE COACHING AND/OR TRAININGPER/81.1-0298PER88.2EMPLOYEE COMMENTSPER/88.2-1100 PER21EMPLOYEE DISCIPLINARY REPORTPER/21-810 ID#2EMPLOYEE IDID#2PER23EMPLOYEE INFORMATION FORMPER/23-714PER88EMPLOYEE OF THE MONTH BALLOTPER/88-100 PER15EMPLOYEE REFERENCE REQUESTPER/15-215PER20.7EMPLOYEE TRANSFER CHECKLISTPER/20.7-114PER10.1EMPLOYMENT DATA RECORDPER/10.1-806 SO1205EMPLOYMENT HISTORYSO/1205-0692PER23EMPLOYMENT INFORMATION FORMPER/23-610PER40.17EPI-PEN COMPETENCYPER/40.17-414SR206ESSENTIAL INFORMATIONSR/206-1214SO710EXAMPLES OF PSYCHOTROPIC MEDICATION AS OF 1999SO/710-1000 PER91EXIT INTERVIEWPER/91-401 SO548EXPENDITURE REPORTSO/548-1204BBAS2030EXPOSURE DETERMINATION FORMBBAS/2030-1201 SR850.3EZ LIFT SAFETY & MAINTENANCE CHECKLISTSR/850.3PER28FAIR LABOR AGREEMENT FOR HOURLY, NON-EXEMPT EMPLOYEESPER/28.4-814 PER28.6FAIR LABOR AGREEMENT FOR LIVE-IN COUNSELORPER/28.6-811SR1598.1FAX FORM – CASE MANAGEMENTSR/1598.1-900 SR1598FAX FORM – THOMAS ALLEN, INC.SR/1598-1201 SS450.4FILE AUDIT – WAIVERED CLIENT RECORDS - SUPPORT SERVICESSS/450.4-1212SILS450 FILE AUDIT – INDIVIDUAL CLIENT RECORDS RULE 18 (SILS)SILS/450-203 ICF450-1FILE AUDIT: INDIVIDUAL CLIENT RECORDS - ICF/MRICF/450.1-413 SS450FILE AUDIT – SUB-CONTRACTED CLIENT RECORDS – CONSOLIDATED STANDARD (SUPPORT SERVICES)SS/450-413SO543FINANCIAL LOGGINGSSO/543-505SO340FIRE AND TORNADO DRILL SCHEDULESO/340-1289TA343FIRE SYSTEM EQUIPMENT CHECKLIST – THIRD AVENUE AND CORNER PLACETA/343-1002 SR755FIRST AID KIT CHECKLISTSR/755-114 SO351FOOD INVENTORY MISCELLANEOUS SO/351-103SR1650FORMS REVIEWSR/1650-715 SR208FUNCTIONAL ANALYSIS OF CHALLENGING BEHAVIOR(S)SR/208-114SES204FUNCTIONAL ASSESSMENTSES/204-415SR204FUNCTIONAL ASSESSMENT (REQUIRED FOR CLIENTS WHO RECEIVE 24-HOUR SERVICESSR/204-114PER39.2FUNERAL LEAVE REQUESTPER/39.2-411SO642GENERAL LOGGINGSSO/642-109SR1320GRIEVANCE REPORTSR/1320-214SR650GROOMING CHECKLISTSO/650-0990CM407GUARDIAN & FAMILY SATISFACTION SURVEYCM/407-909 SILS407GUARDIAN, FAMILY & SOCIAL WORKER SATISFACTION SURVEYSILS/407-403SR126.1GUIDELINES FOR COMPLETING DEMISSION SUMMARYSR/126.1-0894CM1462GUIDELINES FOR DATA PRIVACYCM/1462-100 FC1588HANGING FILES & FILE FOLDERS – ORDER FORMFC/1588-306 SO702.1HEALTH CARE/EQUIPMENT & PSYCH. MED. MONITORING FORMSO/702.1-299 SO712HEALTH CARE PLANSO/712-414SR1044 HEALTH MAINTENANCE REPORTED INCIDENTSSR/1044-901 SR708.1HEALTH NEEDS NOTIFICATION LOGSR/708.1-115SR708HEALTH NEEDS REVIEW AND AUTHORIZATIONSR/708-115 PER40.15HEALTHY DIET RESOURCE GUIDEPER/40.15-114PER40.14HEALTHY DIET - TEST OUTPER/40.14-215BBAS2035HEPATITAS B CONSENT AND VACCINATION FORMBBAS/2035-814SR100HISTORY OF THOMAS ALLEN, INC.SR/100-111 FC350HOME SAFETY CHECKLISTFC/350-899 ICF105.4HOSPITAL TRANSFER AGREEMENTICF/105.4-0190SO594HOUSEHOLD ACCOUNT WORKSHEETSO/594-308SO593HOUSEHOLD ACCOUNT ANALYSIS WORKBOOK (excel documentSO/593-614SR1509HOUSEHOLD EQUIPMENT MONITORINGSR/1509-707SR598HOUSEHOLD FINANCIAL AUDIT REPORTSR/598-807SR1555HOUSEHOLD ITEMS FOR PROGRAM START UPSR/1555-1109SILS1310ILS GOAL STATEMENTSILS/1310-707SILS1310.1ILS GOAL STATEMENT (WITH DEMOGRAPHIC BOX)SILS/1310.1-411SILS1310.2ILS GOAL STATEMENT (DAKOTA COUNTY)SILS/1310.2-411PER25IMMEDIATE RELEASEPER25-0791ICF/FC741IMMUNIZATION RECORDICF/FC741-0290 SO405IN CASE OF DEATH/BURIAL INFORMATIONSO/405-1092 SS1030IN-HOME PARENT SUPPORTING SERVICES QUARTERLY AGGREGATE REPORTSS/1030-401 SR1021INCIDENT REPORT SR/1021-914SR211INDIVIDUAL ABUSE PREVENTION PLANSR/211-1214CM1012INDIVIDUAL SERVICE PLAN (CASE MANAGERS)CM/1012-200CM1012-1INDIVIDUAL SERVICE PLAN (OLMSTED COUNTY)CM/1012-1.200CM1012-2INDIVIDUAL SERVICE PLAN (GOODHUE COUNTY)CM/1012.2-200CM1012-3INDIVIDUAL SERVICE PLAN (YELLOW COUNTY)CM/1012.3-907 CM1012-4INDIVIDUAL SERVICE PLAN (RAMSEY COUNTY)CM/1012.4-200 CM1012-5INDIVIDUAL SERVICE PLAN (WASHINGTON CTY)CM/1012.5-200 CM1012-5aINDIVIDUAL SERVICE PLAN FORM B (WASHINGTON CTY)CM/1012.5a-203CM1012-6INDIVIDUAL SERVICE PLAN (WINONA COUNTY)CM/1012.6-402 CM1012-7INDIVIDUAL SERVICE PLAN (WASECA COUNTY)CM/1012.7-505CM1012-8INDIVIDUAL SERVICE PLAN (KOOCHICHING COUNTY)CM/1012.8-108 CM1012-10INDIVIDUAL SERVICE PLAN (ANOKA COUNTY)CM/1012.10-501 CM1012-10.5INDIVIDUAL SERVICE PLAN (ANOKA COUNTY) CHILDCM/1012.10.5-1210 CM1012-12INDIVIDUAL SERVICE PLAN (LE SUEUR COUNTY)CM/1012.12-1103 CM1012-13INDIVIDUAL SERVICE PLAN (SCOTT COUNTY)CM/1012.13-904 CM1012.14INDIVIDUAL SERVICE PLAN (HENNEPIN COUNTY)CM/1012.14-306PER14-2INFORMED CONSENT – BCAPER/14.2-200 SR710-41INFORMED CONSENT FORM FOR THE ADMINISTRATION OF PSYCHOTROPIC MEDICATION(S)SR/710.41-913CONNECTSERVICES201INITIAL DIAGNOSTIC ASSESSMENT CONNECTSERVICES/201-210SO106INITIAL REFERRAL INFORMATIONSO/106-714 PER81.1INSTRUCTIONAL SUMMARYPER/81.1-204SR106.1INTAKE & DEMISSION DATA FOR CLIENTSR/106.1-1014 PER20.6INTELLICORP BACKGROUND STUDY DISCLOSURE AND AUTHORIZATION FORMPER/20.6-415SR220INTENSIVE SUPPORT SERVICES ASSESSMENT AND SUMMARYSR/220-1214SR220.4INTENSIVE SUPPORT SERVICES ASSESSMENT AND SUMMARY FOR SUPPORTED EMPOYMENT SERVICES (SES)SR/220.4-315OAKWARAVE691INTER-RATER OBSERVATIONSOAK/WAR/AVE/691-1190PER/10.2INTERNAL APPLICATIONPER/10.2-914SILS450-1INTERNAL FILE AUDIT: INDIVIDUAL CLIENT RECORDS (SCATTERED SITES)SILS/450.1-609SR1005-3 INTERNAL REVIEW COMMITTEES APPROVAL FOR USE OF CONTROLLED PROCEDURESR/1005.3-597SO1035INVITATION REQUEST (FOR CLIENT REVIEW MEETING)SO/1035-114ICF711IRC REVIEW OF PSYCHOTROPIC MEDICATIONICF/711-307CM1013ISP FACE SHEETCM/1013-707CM1029ISP SIGNATURE REQUESTCM/1029-1199 FIN06JOURNAL ENTRY DETAILFIN/06-405SO714-1LAB RESULTSSO/714.1-0193LV800LAKEVIEW MONTHLY CLEANING CHECKLISTLV/800-0598SO750LEAVE DAYSO/750-1214PER39.4LEAVE OF ABSENCE – CERTIFICATION OF PHYSICIAN OR PRACTITIONER(PDF file, if you do not have Adobe, please ask for a paper copy)PER/39.4-914PER39.1LEAVE OF ABSENCE REQUESTPER/39.1-714PER39.5LEAVE OF ABSENCE STATUS REPORTPER/39.5-614SO942LEISURE RECORDSO/942-1205PER49-3LETTER OF TERMINATIONPER/49.3SO1406LICENSING INFORMATION BY COUNTY, RULE, PROGRAM AND CLIENTSO/1406-1114SR300LIVE-IN COUNSELORS DAMAGE DEPOSIT AGREEMENTSR/300-304SO641.1LOG ENTRY GUIDELINESSO/641.1-505PER40.13LIFE SUSTAINING MEDICAL EQUIPMENT (LSME) COMPETENCY – TEST OUTPER/40.13-314SR850MAINTENANCE - MONTHLY CHECKLIST SR/850-114 SR820MAINTENANCE NEEDS QUADRANTSR820-212MAINTENANCE PRE-EMPLOYMENT TESTSR890MAINTENANCE REQUEST/REPLY FORMSR/890-403SO617MAINTENANCE/ROUTINE DAILY LIVING GOALSSO/617-807SR850.1MAINTENANCE - SEASONAL/AS NEEDED CHECKLIST SR/850.1-114 SR852MAINTENANCE STAFF SIGN IN SHEETSR/852-212 CE36.1MAINTENANCE TIME RECORDCE/36.1-0591PER38.1MAINTENANCE TIME SHEETPER/38.1-1214 SR1557MAJOR START UP PURCHASESSR1557-1109SO641-5MALADAPTIVE BEHAVIOR RECORDING SHEETSO/641.5-200 SR1022MALTREATMENT OF VULNERABLE ADULT INCIDENT REPORTSR/1022-114PER49.6AMANDATORY TRAINING WARNING (NON 245 D)PER/49.6A-314 PER49.6BMANDATORY TRAINING WARNING (245 D PROGRAMS)PER/49.6B-314 PER49.7AMANDATORY TRAINING SUSPENSION NOTICE (NON 245D PROGRAMS)PER/49.7A-214 PER49.7BMANDATORY TRAINING SUSPENSION NOTICE (245D PROGRAMS)PER/49.7B-214 SR/202.1MANUAL OPERATION OF VAN LIFTSR/202.1-1114SR748MEDICAL APPOINTMENTS RECORDSR/748-403SR1555.1MEDICAL ITEMS FOR PROGRAM START UPSR/1555.1-1109SO747MEDICAL LOGGINGSSO/747-899 SO740MEDICAL MONITORING TOOLSO/740-307PER42.7MEDICATION ADMINISTRATION SKILLS DEMONSTRA-TION CHECK-OFF LIST PER/42.7-215 IFC42MEDICATION CLASS TESTIFC42-889OAK780MEDICATION DESTRUCTION FORMOAK/780-0191SO700.3MEDICATION/TREATMENT ADMINISTRATION RECORD DOCUMENTATION RECORDSO/700.3-314SR720MEDICATION/TREATMENT ERROR REPORTSR/720-114SO791MEDICATION TERMSSO/791-0895SO1131MEETING AVAILABILITY TRACKING TOOLSO/1131-307SILS435MEETING SCHEDULE CHECKLISTSILS/435-0398SO715MENSTRUAL CHARTSO/715-0191SO310MENU PLANNINGSO/310-908MID800MIDLAND CLEANING SCHEDULEMID/800-1198 SO710.71MONITORING OF SIDE EFFECTS SCALE (MOSES) (PDF file, if you do not have Adobe, please ask for a paper copy)SO/710.71-913SS1045.1MONTHLY BILLING SHEET - QMRP SERVICESSS/1045.1-599SR592MONTHLY MAINTENANCE ACCOUNT ANALYSISSR/592-114 SR616MONTHLY REVIEW OF OBJECTIVESSR/616-1111PER19MOTOR VEHICLE RECORD RELEASEPER/19-814ICF1010.3NEED AREAS AND OBJECTIVES (ICF/MR ONLY)ICF/1010.3-706SR710-11NEUROLEPTIC MALIGNANT SYNDROME (NMS) INFORMATION SHEETSR/710.11-206SO710.2NEW ADMITS ALREADY PRESCRIBED PSYCHOTROPIC MEDICATIONS CHECKLISTSO/710.2-108PER20.1NEW EMPLOYEE CHECKLISTPER/20.1-215PER11NEW HIRE BROCHUREPER/11-715PER20.2NEW HIRE CHECKLISTPER/20.2-914PER18NEW HIRE UNDERSTANDINGPER/18-714PER8.1NON-DIRECT CARE POSITION REQUISITIONPER/8.1-914SR1046.1NON-VULNERABLE ADULT/MALTREATMENT OF MINORS REPORTED INCIDENTSSR/1046.1-306PER20NOTICE OF MISSING PERSONNEL FORMSPER/20-1098 PER49.8ANOTICE TO EMPLOYEE OF UPCOMING MANDATORY TRAINING (NON 245 D PROGRAMS)PER/49.8A-214PER49.8BNOTICE TO EMPLOYEE OF UPCOMING MANDATORY TRAINING (245 D PROGRAMS)PER/49.8B-214SR101NOTICE OF PRIVACY PRACTICESSR/101-913FC786NOTIFICATION OF REPORTABLE COMMUNICABLE DISEASESFC/786-1099 SR1595.1NOTIFICATION OF REVISION TO COMPANY POLICY AND/OR PROCEDURESR/1595.1-1299 BC720NURSING CARE PLAN – ASSESSMENT & QUARTERLY REVIEWBC/720-803 CM1150OBRA SCREENINGSCM/1150-0992SR1469OMBUDSMAN DEATH REPORT FORMSR/1469-499 SR1467OMBUDSMAN SERIOUS INJURY REPORT FORMSR/1467-112 PER65ON-CALL EMPLOYEE AVAILABILITYPER/65-1098 SO1170ON-CALL EMPLOYEE CONTACTSSO/1170-0490PER85ON-CALL EMPLOYEE PERFORMANCE REVIEWPER/85-114 SO1300ON-CALL GUIDELINESSO/1300-1098 PER70ON-CALL STAFF POLICYPER/70-815FC1589ORDER SHEET FOR BOOKS/MISCELLANEOUS SLS PROGRAM MATERIALSFC/1589-798 PER41.3ORIENTATION - FLOATERPER/41.3-314 PER41.4ORIENTATION – GUIDELINES FOR TEMPORARY SERVICE COUNSELORPER/41.4-898 PER/42.4ORIENTATION PROGRAM SPECIFIC NURSE CONSULTANTPER/42.4-214PER42.2ORIENTATION – PROGRAM SPECIFIC (RESIDENTIAL)PER/42.2-215PER42.6ORIENTATION – SCATTERED SITESPER/42.6-714 PER42ORIENTATION – SPECIFIC CASE MANAGEMENTPER/42-914CONS339ORIENTATION – SPECIFIC CONSERVATOR/GUARDIANSHIPCONS/339-714 PER42.3ORIENTATION – SPECIFIC MANAGED CAREPER/42.3-714PER42.5ORIENTATION – SPECIFIC NURSE CONSULTANT-SUPERVISOR’S TRAININGPER/42.5-214 PER44.1ORIENTATION – SPECIFIC SUPERVISORYPER/44.1-1114PER41.1ORIENTATION – STANDARD GUIDELINESPER/41.1-309 PER45ORIENTATION – STANDARD SUPERVISORYPER/45-613 PER45.1ORIENTATION – STANDARD SUPERVISORY GUIDELINESPER/45.1-803 PER42.8ORIENTATION – SUPPORTED EMPLOYMENT SERVICESPER/42.8-315SR1029-1OUTCOME MEASURES REFERENCE GUIDESR/1029.1-201 PER03OUTSTANDING PERFORMANCEPER/03-415SR500OVERTIME USE REPORTSR/500-1114CM1581PAGE DIVIDER ORDER FORMCM/1581-1002 CM1580PAGE DIVIDER ORDER FORM – CADI/TBICM/1580-1002 CM1582PAGE DIVIDER ORDER FORM – RULE 185CM/1582-106PER30PAYROLL DIRECT DEPOSIT AUTHORIZATIONPER/30-414 PAYROLL SCHEDULE 2009HCS1045PCS HOURS BILLEDHCS/1045-299SILS943PEER GROUP SUMMARYSILS/943-807PER89PERFORMANCE REVIEWPER/89-1112SR450PERMANENT FILE AUDIT: CLIENT RECORDS - RULE 245DSR/450-315 SR1029PERSON CENTERED PLANNING TOOL (PCPT)SR/1029-314 SR1029.2PERSON CENTERED PLANNING TOOL (PCPT) NON-VERBAL/LOWER FUNCTIONING CLIENTSSR/1029.2-714 SES1029PERSON CENTERED PLANNING TOOL (PCPT) SES CLIENTSSES/1029-415PERSONAL MEMO’SSO155PERSONAL ITEMS TRANSFER - CLIENT DISCHARGESO/155-0290PER13-2PERSONAL TELEPHONE REFERENCEPER/13.2-497PER34PERSONNEL STATUS CHANGE NOTICEPER/34-913PER22.1PERSONNEL TUBERCULOSIS CLEARANCE REPORTPER22.1-1293FIN08PETTY CASH DISBURSEMENTS – CO FIN/08-405SO545PETTY CASH LEDGERSO/545-1005 SO581PETTY CASH SLIPSO/581-1003SO640-1PHONE CALL LOGSO/640.1-201 SO710-1PHYSICIAN RATIONALE FOR MEDICATIONSO/710.1-206SR1005.2PHYSICIAN’S ASSESSMENT – AVERSIVE/DEPRIVATION PROCEDURESR/1005.2-0295SR1005.8PHYSICIAN’S REPORT – EMERGENCY USE OF A MANUAL RESTRAINTSR/1005.8-1014SR1595POLICY BOOK CHANGESR/1595-715 SR107PRELIMINARY CSSP ADDENDUM/ADMISSION MEETING SUMMARYSR/107-1214 SR107-1PRELIMINARY CSSP ADDENDUM AND ADMISSION MEETING SUMMARY GUIDELINESSR/107.1-614 SR710-9PRN (PRO RE NATA) “AS NEEDED” BEHAVIORAL AND PROCEDURAL CRITERIASR/710.9-206SR710-1PRN USAGE REPORTSR/710.1-309SR209.1PROGRAM ABUSE PREVENTION PLANSR/209.1-1114SR209PROGRAM ABUSE PREVENTION ASSESSMENT PLAN AND CHECKLISTSR/209-114SO595PROGRAM ACCOUNT ANALYSISSO/595-411 SR1140PROGRAM CHART (QUARTER)SR/1140.JFM15(ETC..) SR1140-1PROGRAM CHART (QUARTER)SR/1140-1.JFM14(ETC..) SO640PROGRAM CHART – STEPS SO/640-1289SR643PROGRAM COMMENTSSR/643-806 FC-ICF451PROGRAM DIRECTOR ON-SITE REVIEWFC-ICF/451-1014FC-ICF451.1PROGRAM DIRECTOR ON-SITE REVIEW AND PROGRAM SURVEY SCHEDULE 2014FC-ICF/451.1-214 FC450 PROGRAM FILES CHECKLIST – CONSOLIDATE STANDARD AND 203 PROGRAMSFC/450-108SO450PROGRAM FILES CHECKLIST – SILSSO/450-203 SR1556PROGRAM ITEMS TO PURCHASESR/1556-1109PER73PROGRAM MANAGER RESPONSIBILITIESPER/73-807SO690PROGRAM MANAGER REVIEW OF SERVICESSO/690-114 SR1171PROGRAM MANAGER TASK DUE DATESSR/1171-813SO625 PROGRAM MONTHLY REVIEWS FOR CLIENTSSO/625-1297PER/42.2PROGRAM SPECIFIC ORIENTATION – RESIDENTIAL PER/42.2-1111 SR1027-1PROGRESS REPORT - GUIDELINES FOR COMPLETIONSR/1027.1-214 SEAS1027-2PROGRESS REPORT MEETING SUMMARY - SEASSEAS/1027.2-300FC1550PROJECT TASK SHEETFC/1550-0696 SR1000PROPERTY & VEHICLE REPORTSR/1000-505SO710.3PROPOSED PSYCHOTROPIC MEDICATION USE/NON-EMERGENCY CHECKLISTSO/710.3-108SO711PSYCHOLOGICAL INFORMATION REPORTSO/711-0791SR710-6PSYCHOTROPIC DATA SUMMARYSR/710.6-206SR710-42PSYCHOTROPIC INITIATION: EMERGENCYSR/710.42-206SR703.1PSYCHOTROPIC MEDICATION EVALUATION APPOINTMENTSR/703.1-114SR709-6PSYCHOTROPIC MEDICATION HISTORYSR/709.6-206SO710-4PSYCHOTROPIC MEDICATION JUSTIFICATION LETTERSO/710.4-107SO710.5PSYCHOTROPIC MEDICATION MONITORING TOOLSO/710.5-509SO716PSYCHOTROPIC MEDICATION MONITORING TOOLSO/716-307SR1024PSYCHOTROPIC MEDICATION REVIEWSR/1024-115SR710PSYCHOTROPIC MEDICATION USE CHECKLIST (PMUC)SR/710-706CM1002QUALIFICATION AGREEMENT – CASE MANAGEMENTCM/1002-906ICF1028QUARTERLY HEALTH CARE EXAMINATIONICF/1028-207 SO1030QUARTERLY SAFETY & EMERGENCY PROCEDURES REVIEW CHECKLISTSO/1030-1199 PER52.5QUIT SMOKING INCENTIVE PROGRAM ENROLLMENTPER/52.5-1108CM1598.3RAMSEY COUNTY COVER SHEET CM1598.3-413CM1012.4ARAMSEY COUNTY RELOCATION PLANCM/1012.4A-402SR560RATE CHANGE LETTERSR/560-1199 CONS440.1RECAPITULATION SUMMARY AND DESCRIPTION OF SERVICESCONS/440.1-109SO552.1RECORD OF INCOMESO/552.1-0290FIN07RECORD OF KEYS – 1550 HUMBOLDTFIN/07-0693SR1540RECORD OF LONG DISTANCE PHONE CALLSSR/1540-297ICF22-2RECORD OF STAFF MANTOUXICF/22.2-609BC43RECORD OF STAFF TRAINING IN USE OF MEDICAL EQUIPMENTBC/43-813SO750RECORD OF THERAPEUTIC LEAVES & HOSPITAL STAYSSO/750-210 SO849RECORD OF VEHICLE USESO/849-1289CONNECTSERVICES107REFERRAL & INTAKE FORMCONNECTSERVICES/107-210SR105REFERRAL QUESTIONNAIRESR/105-114 SEAS105-1REFERRAL SUMMARY – SEASSEAS/105.1-202 SR105-1REFERRAL SUMMARYSR/105.1-1299 SR105-2REFERRAL SUMMARY INSTRUCTIONSSR/105.2-1299 SR707REFUSAL FOR MEDICAL EXAMSR/707-412PER47.1REGISTRATION FOR TRAININGPER/47.1-108PER47.4REGIS FOR ORGANIZATIONAL IN-SERVICEPER/47.4-612PER33REIMBURSEMENT CLAIMPER/33-115CM461RELOCATION SERVICE COORDINATION AUDITCM/461-1002 CM1023REPORT OF CHANGECM/1023-302 SR406REQUEST FOR ACCOUNTING OF DISCLOSURESSR/406-403SR1010.3REQUEST FOR APPROVAL TO REVISE/ANENDSR/1010.3-114PER47REQUEST FOR ONGOING TRAININGPER/47-1214 PER39.3REQUEST FOR DONATION OF PAID TIME OFFPER/39.3-1100 SR1590REQUEST FOR GENERAL OFFICE SUPPLIESSR/1590-215SR220-2REQUEST FOR COORDINATED SERVICE AND SUPPORT PLAN (CSSP)SR/220.2-114 SR617-1REQUEST FOR REVISION TO SERVICE OUTCOME PLAN COORDINATED SERVICE AND SUPPORT PLAN ADDENDUMSR/617.1-114PER39REQUEST FOR TIME OFFPER/39-1013 SS105-2RESPITE/FOSTER CARE AGREEMENTSS/105-2.1201 SR403.2RIGHT RESTRICTION PLANSR/403.2-114SO108-2RIGHTS AND RESPONSIBILITIESSO/108.2-1214DD-DAK697RISK MANAGEMENT ASSESSMENT AND PLAN DAKOTA COUNTYDD-DAK697DD-DAK697.1RISK MANAGEMENT ASSESSMENT AND PLAN DAKOTA COUNTY INTERPRETIVE GUIDEDD-DAK697.1DD-DAK697.2RISK MANAGEMENT ASSESSMENT AND PLAN DAKOTA COUNTY BEST PRACTICESDD-DAK697.2DD-DAK697.3RISK MANAGEMENT ASSESSMENT AND PLAN DAKOTA COUNTY HELPFUL HINTSDD-DAK697.3SR/211.1RISK MANAGEMENT ASSESSMENT AND PLAN INSTRUCTIONSSR/211.1-109PER40.5RISK MANAGEMENT POST-TESTPER/40.5-908PER88.3 ROOKIE OF THE MONTH BALLOTPER/88.3-111 FC305ROOMMATE CONSENTFC/305-1189SO614ROUTINE DAILY LIVING SKILLSSO/614-114 SR1599-1ROUTING SLIP – PROGRAMSSR1599.1/1112SR1599ROUTING SLIPSR/1599-715 SR241RULE 40 INDIVIDUAL PROGRAM PLAN REQUIREMENTS CHECKLISTSR/241-0194SO750.1RUNNING TOTALS OF THERAPEUTIC LEAVESSO/750.1-0490SILS1029SAFETY & EMERGENCY PROCEDURES REVIEW GUIDELINESSILS/1029-908SR450-1SATISFACTION SURVEYSR/450.1-103 SS450-1 SATISFACTION SURVEY – SUPPORT SLS PROVIDERSSS/450.1-1013SO450-4SATISFACTION SURVEY RESULTSSO/450.4-412 SR450-3SATISFACTION SURVEY TALLYSR/450.3-1005 SILS1506SCATTERED SITES BILLING REPORTSILS/1506-0397SILS440SCATTERED SITES CLIENT CONTACT LOGSILS/440-307 SILS/1045.2SCATTERED SITES COORDINATOR – TIME REPORTSILS/1045.2-599 SO1202SCHOOL INFORMATION/HISTORYSO/1202-1098 SO723SEIZURE CHARTSO/723-989 SO722.1SEIZURE LOGSO/722.1-307SR721SEIZURE PLAN OF CARESR/721-0296SO724SEIZURE RECORDSO/724-0591SO722SEIZURE REPORTSO/722-403BC722 SEIZURE REPORTBC/722-200 SO701.1SELF-ADMINISTRATION OF MEDICATION (b.i.d.)SO/701.1-1195SO701.2SELF-ADMINISTRATION OF MEDICATION (q.d)SO/701.2-0791SO701.3SELF-ADMINISTRATION OF MEDICATION (t.i.d.)SO/701.3-0791PER89.1SELF-APPRAISALPER/89.1-1112PER91SEPARATION/EXIT INTERVIEWPER/91-497SR1467SERIOUS INJURY REPORTSR/1467-612 SR560SERVICE COST LETTERSR/560-0298SR617SERVICE OUTCOME PLANSR/617-314 SR617-2SERVICE OUTCOME GUIDELINESSR/617.2-114SR1027SERVICE PLAN REVIEW REPORT SR/1027-1214SR1027.2SERVICE PLAN REVIEW MEETING SUMMARYSR/1027.2-1214SES1045SES BILLING SHEETSES/1045-715PER17SEXUAL EXPLOITATION ACTION FOR PSYCHOTHERAPISTSPER/17-0994PER16SEXUAL EXPLOITATION REQUESTPER/16-215PER22SIGNATURE PAGE FOR POLICY REVIEWPER/22-806SILS701.1SILS EMERGENCY PROCEDURE & MEDICAL RECORDSILS/701.1-599 SILS451 SILS PROGRAM FILES - ADMISSION CHECKLISTSILS/451.108OAK781SILVER OAKS NUTRITION ASSESSMENTOAK/781-314SR1342SITE SPECIFIC EMERGENCY PROCEDURESR/1342-914SM89.2SIX-MONTH EMPLOYEE PERFORMANCE REVIEW (CASE MANAGEMENT)CM/89.2-706SO200SKILLS ASSESSMENTSO/200-499 SO641.1SLEEPING HOURS DATA SHEETSO/641.1-0591FC1551SLS ITEMS TO POSTFC/1551-1109CM220SOCIAL AND HEALTH HISTORYCM/220-0792SR1030SPECIAL SUPPORT TEAM MEETINGSR/1030-114TBI1013.1SPECIFIC JOB SITE DESCRIPTION – TBI PROGRAMTBI/1013.1-1199 PER42.1SPECIFIC ORIENTATION GUIDELINES - CASE MGMT.PER/42.1-807 CE44SPECIFIC ORIENTATION - COMMUNITY EMPLOYMENT CE/44-803CE45SPECIFIC ORIENTATION GUIDELINES - COMMUNITY EMPLOYMENT CE/45-807PER42.10SPECIFIC ORIENTATION – MAINTENANCE PER/42.10-1109CM590.1SPEND DOWN LETTER 1CM/590.1-714CM590.2SPEND DOWN LETTER 2CM/590.2-714CM590.3ASPEND DOWN LETTER 3ACM/590.3A-714CM590.3BSPEND DOWN LETTER 3BCM/590.3B-714SSP701.1SSP SITE EMERGENCY PROCEDURE & MEDICAL RECORDSSP/701.1-1002 PER40.3STAFF REVIEWPER/40.3-299 SO1309STAFF SIGNATURE PAGESO/1309-0296SR110STAFF TRAININGSR/110-414PER48STAFF TRAINING CALENDAR 20__PER/48-914 PER40.4STAFF TRAINING SIGNATURE PAGEPER/40.4-1100 SO1173STAFFING SCHEDULESO/1173-0490PER41STANDARD ORIENTATION PER/41-215 SR771STANDING ORDERS FOR OVER THE COUNTER/ PRN MEDICATIONS SR/771-1013 SR1580STATEWIDE OPENINGS LISTSR/1580-799 SR109STATEMENT OF ACKNOWLEDGEMENTSSR/109-315 SO1592SUMMARY OF SERVICESSO/1592-607PER80SUPERVISOR EVALUATIONPER/80-1005 SR221SUPPORT AND MONITORING SERVICESSR/221-706PER85.1SUPPORT SERVICES EMPLOYEE PERFORMANCE REVIEWPER/85.1-1210SS86SUPPORT SERVICES SURVEYSS/86-399 SS1029SUPPORT SERVICES TIME REPORT – RESPITESS/1029-1101 SS36SUPPORT SERVICES TIME SHEETSS/36-1214SS36.1SUPPORT SERVICES TIME SHEET – MULTIPLE CLIENTSSS/36.1-1214 PER80-1SUPPORT STAFF EVALUATIONPER/80.1-497SR106SUPPORT TEAM MAILING LISTSR/106-1214 CM1520SUPPORTING SCHEDULE:COUNTY INVOICE FOR OBRA PASSARR ACTIVITYCM/1520-1197SR1020SUSPECTED CHILD MALTREATMENT REPORTING FORMSR/1020-1198 SR1506TAI CELL PHONE CHECK OUTSR/1506-906SS400TAI EMPLOYEE/FOSTER PROVIDER AGREEMENTSS/400-501 TAI CM LETTERHEADTAI CONSULTING LETTERHEADTAI LETTERHEADSR709-2TARDIVE DYSKINESIA (TD) INFORMATION SHEETSR/709.2-206SO641-6TASK ANALYSIS (STEPS 1 - 22)SO/641.6-0191SO641-4TASK ANALYSIS DATA SHEETSO/641.4-1290PER01ATELECOMMUTER CONTRACTPER/01A-615PER01BTELECOMMUTER CONTRACT ADDENDUMPER/01B-1114SR740TELEPHONE CONSULTSR/740.897CM645TELEPHONE LOGCM/645-1003PER13TELEPHONE REFERENCE CHECKPER/13-415 PER82TEMPORARY SERVICE COUNSELOR PERFORMANCE EVALUATIONPER/82-806PER36TIME CARDPER/36-1214 PER36.2TIME CARD – FLOATER/NURSE CONS./TEMP. SVCS.PER/36.2-1214 SILS1045TIME REPORT/DIRECT TIMESILS/1045-114 CM1041.4TIME & ACTIVITY – SCOTT COUNTYCM/1041.4-108CM1041.3TIME & ACTIVITYCM/1041.3-108CM1041.2TIME SHEET – ANOKA COUNTYCM/1041.2-806CM1041TIME SHEET – CASE MANAGEMENTCM/1041-108PER45.2TRAINING CALENDAR REQUIREMENTS CHECKLISTPER/45.2-214PER40ATRAINING DOCUMENTATION (NON 245 D)PER/40A-415PER40BTRAINING DOCUMENTATION (245 D PROGRAMS)PER/40B-315CM40TRAINING DOCUMENTATION CASE MANAGEMENT & MANAGED CARECM/40-315PER43TRAINING IN USE OF MEDICAL EQUIPMENTPER/43-901 PER48-1TRAINING RECORD FOR OUTSIDE SERVICE STAFFPER/48.1-815 PER49-1TRAINING STATUS NOTICE PER/49.1-1013 PER49-2TRAINING SUSPENSION NOTICEPER/49.2-1013 PER49-5TRAINING STATUS WARNINGPER/49.5-1112 PER47.3TUITION REIMBURSEMENT APPLICATIONPER/47.3-215SO1174TWO WEEK STAFFING PATTERNSO/1174-0490ICF205UTILIZATION REVIEW PLANICF/205-0190SR1553.2VAN QUARTERLY CHECKLISTSR1553.2-1211SR/1350VAN SAFETY TEST OUT USING Q’STRAINTS - SEE ALSO (ASSESSMENT OF STAFF-VAN LIFT OPERATIONS & WHEELCHAIR SECUREMENT TECHNIQUES (SR202)SR/1350-309SR1021-1VEHICLE ACCIDENT REPORT GUIDESR/1021.1-212 SO1244VOCATIONAL LOGGINGSSO/1244-505SR1046VULNERABLE ADULT INCIDENT REPORT & STATUS OF INTERNAL VA INCIDENT REPORTSR/1046-1195 PER50WAIVER OF RESPONSIBILITYPER/50-0993PER56WAIVER OF RENTER’S INSURANCE – LIVE-IN CARE PROVIDERSPER/56-610CM420WAIVER PLAN REQUEST FORMCM/420-103CM501WAIVER REQUEST FORMCM/501-0698 SO251WATER ASSESSMENT TESTSO/251-1297SO851WATER TEMPERATURE REVIEWSR/851-409 SO713WEIGHT AND BLOOD PRESSURE RECORDSO/713-0191PER11WELCOME TO THOMAS ALLEN INCPER/11-1013PER30.1WELLS FARGO PAYCARD ENROLLMENT FORM (PDF file, if you do not have Adobe, please ask for a paper copy)PER/30.1-215PER51WORKERS COMPENSATION FORMS (PDF FILE)PER/51-314SR1591WORK SUBMITTED – REQUEST TABSSR/1591-705 WORKSLIP (FOR COMPUTER GENERATED REPORTS)REVISED: 5/26/05 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download