TransparencyResidential Provider Forms
When it comes to documentation, providers of residential services must comply with ACRC Vendor Agreements and Title 17 Regulations. Service providers must have a Client file for each resident, a Personnel file for each employee and a Residential Facility file for the home itself.
The forms below have been developed by ACRC, CCL and/or residential providers; these are provided for your benefit. Some of the forms listed are required, indicated with “must use this form”; only these forms will be accepted. For those that are identified as “format optional” you may elect to develop one of your own that contains all of the required information.
Should you create a version of one of the “format optional” forms, we encourage you to share your work with your ACRC Facility Liaison or Community Services Specialist.
Client File
ACRC Forms
Recent Picture/Physical Description (format optional)
Client Weight Record (format optional)
Dental Documentation
Seizure Record (format optional)
Physician Documentation
Dental Visit- (must use this form)
Physician Visit (must use this form)
Physician Order (format optional)
Facility/Physician Telephone Communication Form (format optional)
Medication Documentation
Appointment Summary (format optional)
Medication Reason for Use (must use this form)
Medication Transfer Sheet (must use this form)
On-Going Documentation
PRN Medication Record (format optional)
PRN Authorization Letter (must use form)
Personnel File
ACRC Forms
On-Going Notes (format optional)
Daily Activity Log (format optional)
Residential Facility File
Direct Care Staffing Checklist (format optional)
ACRC Forms
Direct Support and Professional Training Certification Information
Grievance Form (must use this form)
Residential File Table of Contents
Weekly Staff Schedule (format optional)
Weekly Resident Accountability (format optional)
Fire Drill Record (format optional)
Consultant Log (must use this form)
SIR Documentation
Mandated Reporting for Children
Mandated Reporting for Elderly and Dependent Adults
Behavior Consultation Guidelines and Form
Behavior Consultation Guideline and Form
Residential Behavior Consultation Log
Additional Resources