Policies, Procedures, and Forms
For 245D Basic and Intensive Services as well as PCA and Adult Day Services
STAR offers digital policies, procedures, and forms for 245D Basic, 245D Intensive Residential Services, 245D Intensive Day Services, 245D Intensive Community-Based Services, PCA, and Adult Day Services. Policies, procedures, and forms can be purchased individually or as a set. A complete listing of policies, procedures, and forms for 245D services is below.
The purchase of a set includes free updates of the 245D policies, procedures, and forms for one year from the date of original purchase. After the first year, you may choose to renew your subscription to continue to receive these updates for the upcoming year.
If you would like to purchase individual forms, you’re looking for policies, procedures, and forms for PCA or Adult Day Services, or you would like more information, please contact us. If you’d like to get started customizing a set of 245D policies, procedures, and forms for your organization, use the link below. Please note that an hour of consultation time is a required part of the customization process.
*Please note that pre-payment is required for initial consulting appointments. Booking is for up to 1 hour of consultation time. Unused time will not be refunded nor credit carried forward.
245D Basic Support Services Policies and Procedures
Basic services include: respite care, 24-hour emergency assistance, personal emergency response, night supervision, homemaker, individual community living support, individualized home support without training
- Admission
- Temporary Service Suspension
- Grievances
- Data Privacy
- Reporting and Review of Maltreatment of Vulnerable Adults
- Reporting and Review of Maltreatment of Minors
- Anti-Fraud
- Alcohol and Drug Use
- Death of a Person Served
- Emergency Use of Manual Restraint
- Service Termination
- Person-Centered Planning and Service Delivery
245D Intensive Support Services Policies and Procedures for Residential, Day, or Community-Based
Residential services (licensed site) include: community residential services, family residential services
Day services (licensed site) include: day support services, prevocational services, employment exploration services, employment development services, employment support services
Community-Based (no licensed site): positive support services, crisis respite, specialist services, semi-independent living services, individualized home support with training, individualized home support with family training, integrated community support, employment exploration services, employment development services, employment support services
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- Admission
- Temporary Service Suspension
- Grievances
- Data Privacy
- Emergency Use of Manual Restraint
- Responding to and Reporting Incidents
- Emergencies
- Reviewing Incidents and Emergencies
- Reporting and Review of Maltreatment of Vulnerable Adults
- Reporting and Review of Maltreatment of Minors
- Safe Transportation
- Anti-Fraud
- Alcohol and Drug Use
- Death of a Person Served
- Universal Precautions and Sanitary Practices
- Health Service Coordination (Residential and Community-Based Only)
- Safe Medication Assistance and Administration
- Service Termination
- Person-Centered Planning and Service Delivery
245D Program and Health Forms
Program Forms
- Rights of Persons Serviced
- Rights Restriction
- Emergency Phone Numbers List
- Admission Form and Data Sheet
- Program Notes
- Service Recipient Record Index
- Funds and Property Authorization
- Policy Orientation Receipt
- Discharge Inventory
- Standard Release of Information
- Specific Release of Information
- Designated Coordinator Checklist
- Designated Manager Checklist
- Admission and Discharge Register
- Admission Refusal Notice
- Coordinated Service and Support Plan Addendum – Intensive
- Coordinated Service and Support Plan Addendum – Basic
- Service Outcome and Support
- Behavior Outcome
- Progress Report and Recommendations
- Service Plan Review Meeting and Attendance Notes
- Temporary Service Suspension
- Service Termination Notice
- Self-Management Assessment
- Staff Orientation Training Plan – General
- Staff Annual Training Plan – General
- Staff Orientation and Annual Training Plan – Person Specific
- Incident and Emergency Report
- Internal Review
- Notification to an Internal Reporter
- Alleged Maltreatment Review Checklist
- Emergency Use of Manual Restraint Incident Report
- Complaint Summary and Resolution Notice
- Person-Centered Planning Tool
- Satisfaction Survey
- Single Dated Signature Page
- Bedroom Sharing Consent
- Plan for Program Closure
- Employment Specialist Checklist
- Billing Information Acknowledgement
Health Forms
- Annual Physical Exam
- Medical Referral
- Dental Referral
- Ophthalmology Referral
- Mental Health Referral
- Standing Order Medication List
- Authorization for Medical Treatment Administration
- Authorization and Agreement for Injectable Medications
- Authorization to Act in an Emergency
- Medication or Treatment Error or Refusal Report
- Health Care Provider Appointment Schedule
- Medication Administration Record Review
- Psychotropic Medication Monitoring Data Report
State Forms (DHS, included at no charge)
- Individual Abuse Prevention Plan – DHS
- Program Abuse Prevention Plan – DHS
- Individual Resident Placement Agreement
- Death and Serious Injury Fax Transmission Cover Sheet
- Death Report Form
- Serious Injury Report Form
- 7176B Residency Agreement Template