personnel forms

Client Intake Packet (BHRF):

1. Face Sheet 
2. General Consent for Treatment 
3. Informed Consent for Treatment 
4. Notification of Fees 
5. Receiving and Refunding Clients Fees 
6. Resident’s Account Balance Sheet 
7. Release of Information 
8. Consent for Routine & Emergency Medical Treatment 
9. Confidentiality and Exceptions to Confidentiality 
10. Client Rights 
11. Resident Responsibilities 
12. House Rules & Behavior Expectations 
13. Search & Seizure Policy 
14. No Harm Agreement 
15. Resident Compliant/Grievance Procedure 
16. Resident Personal Belongings 
17. Gym & Recreational Facilities Wavier Release of Liability 
18. Facility Nutritional Meals Acknowledgment Waiver and Release from Liability
19. List of Medication

Client Intake Packet (COUNSELING, OTC & INPATIENT):

1. Client Intake
2. Client Registration
3. Client Rights - For Signature
4. Client Transport and Transfer Form
5. Comprehensive Nursing Assessment
6. Treatment Plan Template
7. Discharge Plan Template
8. Discharge Follow Up Instructions
9. General Consent for Treatment
10. Informed Consent
11. Informed Consent – Telehealth Outside of the Facility
12. AZ Advanced Directive
13. Healthcare Directive Form
14. Behavioral Health Assessment
15. Brief Mental Health Status Exam for Telehealth Outside of the Facility Session
16. Client Complaint Grievance Form
17. Client Directions for UA
18. Client Harassment Policy

Medical Records (BHRF)

1. Nursing Assessment
2. Nurse Progress Note
3. Behavioral Health Assessment
4. Medication Call-In Log
5. Medication Administration Record
6. HIPAA Medical Record Access Log
7. Medication Tracking Form
8. Controlled Medication Log
9. Medication Disposal Log
10. File Audit
11. Coordination Of Care
12. Notice Of Medication Review
13. Daily Pill Count
14. Resident Refusal of Medication
15. Blood Sugar Monitoring
16. Seizure Monitoring Log
17. Resident Case Presentation
18. Tuberculosis Skin Test
19. Client Outing Request
20. Discharging Against Medical Advice Acknowledgment And Waiver
21. Relapse Prevention Plan
22. Daily Activity Schedule
23. Progress Notes Template
24. Group Counseling Template 
25. Goals & Affirmation Sheet
26. Client Complaint or Grievance Form

Medical Records (OTC & INPATIENT)

1. Controlled medication count sheet
2. Medication disposal log
3. Medication inventory control sheet
4. Medication recall sheet
5. Medication stock control sheet
6. Mental health status exam
7. Psychiatric assessment form
8. Medication call-in log
9. Medication administration record
10. HIPAA medical record access log
11. Medication tracking form
12. Controlled medication log
13. File audit
14. Coordination of care
15. Notice of medication review
16. Daily pill count
17. Refusal of medication

1. Evacuation Drill report
2. Disaster Drill report
3. Incident report 
4. Infection control report 
5. Client survey – On Site
6. Client survey – Virtual
7. Staff Survey
8. Quality Control Analysis
9. Quality Control Summary Report 
10. Governing Authority Annual Meeting – Policy & Procedure Review
11. Governing Authority Annual Meeting – Quality Control Review
12. Daily inspection checklist
13. Monthly inspection checklist 
14. Equipment Inventory and Calibration Test Log
15. First aid kit inventory
16. Air filter logs 
17. Refrigerator temp log
18. Restroom Maintenance Log
19. Residents sign in out 
20. Visitor Sign in-out log 
21. Smoke detector log
22. Water temp log 
23. Daily census log 
24. Toxicology and drug references
25. Transportation folder 

1. Policy & Procedure Audit
2. Agency Fees, Modification & Revalidation Audit
3. Client Chart Audit
4. Personnel File Audit
5. Facility/Physical Plant Inspection
6. Transport & Transportation Audit
7. Quality Assurance
8. Environmental Care Audit
9. Nursing Station Audit