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Uniformity of Practice Committee

Introductory Statement


We began by narrowing the scope of our work to these forms:  incident reports, budget submissions, daily CPS notes, monthly progress notes, attendance, and the service agreement.  After reviewing some of the existing forms in use for each category, we made the following decision.  Daily CPS notes and monthly progress notes do not currently have a required format.  As such, we agreed that creating required forms would place an undue burden on provider agencies, who may already have appropriate forms in place.  The monthly progress note and daily CPS note that we developed are being offered as best practice examples, but we are not recommending that they be adopted as required forms.

We developed forms for incident reports, budget submissions, attendance, and service agreements for the area agency executive directors to review and adopt.  The draft forms were shared with stakeholders from the area agencies and provider agencies.  Some of their feedback was incorporated into the final documents, wherever we felt that the change improved the effectiveness of the form.

During the process, it became clear that our various organizations are at different stages with regard to utilizing electronic forms and on-line electronic records.  To ensure that our new forms increase efficiency, rather than adding another burden to the system, we propose that we permit provider agencies to re-create the standard form in whatever electronic format they currently use.  The expectation is that all the required information would appear on the final product in the same order and format, but the form could be generated in whatever system or manner the agency uses.  For example, a vendor that uses an electronic record system would be free to re-create the standard form with its own software.  This point is critical to ensuring that the standard forms don’t create duplicate work.

Prior to completing the process, the committee was notified that the Bureau of Developmental Services was developing new required forms for both budget submissions and service agreements.  Our work on these was placed on hold. Thus, the final required forms that we are proposing are the incident report and the attendance form.


HRC- Authorization Page- 2016-09

Behavior Plan Requirements- 2016-09

Nursing Medical Intervention Report

Weekly Service Notes (This form is best practice but not required)

Monthly Progress Report (This form is best practice but not required)

Medication Occurrence Form- Statewide Template 2017
          Medication Occurrence Form Directions- 2017

Restraint Form Statewide Template – 2016-09
          Restraint Form Directions- 2017

Incident Report
          Incident Report Directions

Complaint Investigation Response-Template_2017-08
          Complaint Investigation Response- Directions_2017-08

Fire Drill Form_2017-08
          Fire Drill Form_ Directions_2017-08

ITS Global Consent for Visitation

ITS Site Visit Sheet – Electronic

Nursing Evaluation of Transition form 2017
          Nursing Evaluation of Transition-Directions_2018-05

SC 5 day visit form 2017
          SC 5 day visit form-Directions_ 2018-04

Seizure Report-Template_2017-10
          Seizure Report- Directions_2018-05