Forms for DDS - Lane County

Forms for DDS

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Adult Foster Home Forms

FAQ, Guides, and Tools for AFH
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Psychotropics-Interpretive statement August 2023.pdf
AFH Licensing FAQ - Updated 8.15.23.docx

Correcting Documentation Errors
DHS/OHA Forms and Publications - If the form has a form # on the bottom right-hand corner, use this link to download.

How to Access Other Forms
ISP Forms and protocols
Tips for Training Hours
SB99 Transmittal 9.2024
SB 99 FAQ

Individual Records
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Activities Record (Sample)
Balancing Test for Psychotropic Medication (Sample)
Emergency Exit and Safety Orientation for Entry - UPDATED July 2023
Financial Record and Ledger (Sample)
Incident Report
Individual Consent to HCBS Limitations
Mandatory Abuse Reporting for Adults
Medication Administration Record (Sample)
Notice of Involuntary Exit - 0719R (10/2019)
Personal Property Record (Sample)
Physician Visit and Order Form (Sample)
Progress Notes Template - Added July 2023
Resident Agreement Form - Updated April 2024
Resident Bill of Rights
Resident Record Table of Contents (Sample)
Safety Plan
Notice of Non-Discrimination (NDN)

Variance Request Form and Instructions

Personnel, Training and Facility Records
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Application for Employment (Sample)

Complaint Procedure (Must be posted)
Bill of Rights (Must be posted)

Drug Disposal Record (Sample)

Emergency Phone Number List (Sample)

Emergency Plan Template (Fill-able)
Emergency Plan Annual Practice Record - Added July 2023
Emergency Supply List (FEMA Brochure)

Fire Evacuation, Smoke and Carbon Monoxide Detector Checks (Sample)

Floor Plan Guidelines & Window Measurements

Hiring & Training Sub-Caregivers Checklist

ISP and Support Documentation Training

Personnel & Facility Records Checklist

Special & Modified Diets Training Record
Training Log 8.15.23.pdf - Updated August 2023
Substitute Caregiver Orientation Record (Sample)

Child Foster Home Forms

Criminal History Check Request Form

Balancing Test for Psychotropic Medication
Caregiver Orientation for Child Foster
Child Summary Sheet
Correcting Documentation Errors
Direct Deposit Form
Drug Disposal Form and Instructions
Emergency Exit Orientation
Emergency Phone Number List (Sample)
Emergency Plan Template for Child Foster
Emergency Plan Annual Practice
Emergency Supply List (FEMA Brochure)
Evacuation Drill Record
Financial Ledger for Child Foster - NEW MARCH 2023
Household Fire Exit Plan
Incident Report Form
Individual Financial Record
ISP and Support Doc Training Record for CFH
Liability Claim Form
Mandatory Abuse Reporting for Children
Medical Visit Form
Medication Administration Record (MAR)
Personal Property Record
Physician Order Form
Physician Order Terminology
Physician Visit and Order Form
Progress Notes
Professional Responsibilities of the Child Foster Provider
Remember the MAR
Resident Bill of Rights
Safety Assessment for Children with Adults Living in the Home
Table of Contents
Variance Request Form
Weight Record

ISP Forms and protocols

Intake and Eligibility

General Information for All Applicants
Intake Packet for a Child (Ages 0 - 17)
Intake Packet for Adult (Ages 18 and Older)

Información general para todos los solicitantes
Paquete de admisión para un niño (edades 0-17)
Paquete de admisión para adultos (mayores de 18 años)

Employer of Record (EOR) Resources

New - 9/8/2020
What You Need to Know as an EOR - English
What You Need to Know as an EOR - Russian
What You Need to Know as an EOR - Somall
What You Need to Know as an EOR - Spanish
What You Need to Know as an EOR - Vietnamese

Privacy Practices

Notice of Privacy Practices
Notice of Privacy Practices (Spanish)