INNOVATIONS FORMS

Colorado Department of Public Health and Environment Checklist
This document is to support Program Coordinators and Nurse Case Managers to ensure that each community residential home for persons with developmental disabilities, otherwise referred to as group homes, is in compliance with the regulations set forth by the Colorado Department of Public Health and Environment (CDPHE).
For more information contact: MATT BARNERT
Key word search: Environment Checklist, group homes.

Complete House Tour Training Script
Script and checklist for training new employees.
For more information contact: MATT BARNERT
Key word search: training script, house tour.

Equipment Safety Checklist
Innovations Maintenance Department quarterly equipment safety checklist.
For more information contact: MATT BARNERT
Key word search: equipment, equipment safety checklist.

Hot Water Temperature Protocol
Innovations hot water temperature protocol to prevent individuals in services from receiving burns due to hot water exposure.
For more information contact: MATT BARNERT
Key word search: temperature protocol, hot water.

House Tour Form
Innovations form to be completed and signed which documents acknowledgment of responsibilities outlined in the house tour.
For more information contact: MATT BARNERT
Key word search: house tour, training.

IBSSP Blank
Document that outlines the behavioral supports needed for an individual in services (Individual Behavioral Service and Support Plan blank form).
For more information contact: MATT BARNERT
Key word search: IBHS, behavior, behaviors, behavioral, Behavioral Health Services, IBSSP, Individual Behavioral Service and Support Plan

Incident Report Reporting Guidelines
Incident report reporting guidelines for the Division for Developmental Disabilities and the Colorado Department of Public Health and Environment
For more information contact: MATT BARNERT
Key word search: incident report guidelines.

Individual Service and Support Plan Form (ISSP Form Blank)
Form to fill out that specifically outlines the individual service and support plans (ISSP’s) identified in the Individual Plan (IP).
For more information contact: MATT BARNERT
Key word search: ISSP, individual service and support plan, individual, service, services, support, plan, IP, individual plan

Individual Service and Support Plan Instructions
Instructions on how to properly fill out an Individual Service and Support Plan (ISSP).
For more information contact: MATT BARNERT
Key word search: ISSP, individual service and support plan, individual, service, services, support, plan, IP, individual plan

Innovations Car/Van Training for PCA/Group Homes
Innovations checklist documentation of training regarding vehicles used at PCAs and group homes.
For more information contact: MATT BARNERT
Key word search: training, vehicle, car, van, vehicle training, Innovations vehicle training checklist.

Innovations Consumer Personal Inventory
Consumer personal inventory checklist.
For more information contact: MATT BARNERT

Innovations Consumer Specific Training
Form that documents that training on the specific needs of an individual in services has been completed.
For more information contact: MATT BARNERT
Key word search: training, specific, person, IP, ISSP, IBSSP

Innovations Consumer Vacation Form
Innovations Consumer Vacation Form in PDF format (printer friendly)
New vacation form, effective July 1, 2011
Form to be completed to document the use of personal needs funds when an individual in services goes on vacation.
For more information contact: MATT BARNERT
Key word search: vacation, trip, holiday, personal, needs, funds, personal needs funds, PNF, money, monies

Innovations EASE Order Form
E.A.S.E Customer reference sheet for Medicare/Medicaid Covered Clients, including privacy acknowledgement.
For more information contact: MATT BARNERT
Key word search: EASE, E.A.S.E., Medicare, Medicaid, equipment, supplies, order, privacy, HIPPA, confidential, medical, protected, health

Innovations Formal Letterhead
Copy of the Innovations formal letterhead to use or download.
For more information contact: MATT BARNERT
Key word search: letter, letterhead, formal

Innovations Health and Safety Assessment
Required documentation as part of the IP process that outlines the supports an individual in services needs to maintain health and to be safe.
For more information contact: MATT BARNERT
Key word search: health, healthy, safe, safety, assessment, plan, IP

Innovations Live Class Requirements
Document outlining Innovations and Colorado State Regulations requirements for direct care professionals live training for certain classes.
For more information contact: MATT BARNERT
Key word search: training, live classes.

Innovations Live-In Employee Agreement To Perform Duties
Contract to be signed in addition to residential counselor job description.
For more information contact: MATT BARNERT
Key word search: Live-in employee agreement.

Innovations Moving Checklist
Checklist of things to do, and timelines, when someone who receives services is going to move.
For more information contact: MATT BARNERT
Key word search: move, moving, resident, residential, home, house, PCA, personal care alternative

Innovations Occurrance Reporting Manual
An occurrence is a type of incident that is reportable to the Colorado Department of Public Health and Environment, which licenses residential group homes for adults with a developmental disability.
For more information contact: MATT BARNERT
Key word search: occurrence manual, incident, group home.

Innovations Performance Review Form
Basic format for an employee performance review/evaluation.
For more information contact: MATT BARNERT
Key word search: performance, review, evaluation, employee, duties, responsibilities, skills, goals

Innovations Petty Cash Log
Form to document petty cash expenditures for group homes and personal care homes (PCA).
For more information contact: MATT BARNERT
Key word search: petty, cash, log, expenditures, expenses, group, home, personal, care, receipt

Innovations Pre-Par Packet Forms
Forms required to be completed by a Program Coordinator before an IP meeting.
For more information contact: MATT BARNERT
Key word: PAR, par, pre-par, IP, individual plan, coordinator, program coordinator, preparation, SUPERVISOR/COORDINATOR IP CHECKLIST, IP Paperwork Packet.

Innovations Request for Residence Move
Form to be completed to request a move for an individual in a group home or personal care alternative (PCA) home.
For more information contact: MATT BARNERT
Key word search: residence, residential, move, moving, house, home, group, personal care alternative, PCA

Innovations Residential Attendance
Monthly documentation of days in, and absence from, the residence or residential setting for individuals who receive comprehensive services.
For more information contact: MATT BARNERT
Key word search: residence, residential, absence, absent, attendance, visit, Medicaid, comp, comprehensive, services, vacation, hospital, hospitalization

Innovations Residential Staff Training Checklist
Innovations “Becoming a Caregiver” training schedule and outline.
For more information contact: MATT BARNERT
Key word search: training, becoming a caregiver, training checklist, residential staff training checklist, house staff training checklist.

Innovations Water Temperature Log
Innovations monthly water temperature log.
For more information contact: MATT BARNERT
Key word search: water temperature log, hot water protocols.

Notification of Action to be Taken - PDF
Notification of Action to be Taken - .doc
Notification of Action to be Taken - .docx
This form is used by Case Management to inform the consumer and/or guardian of action to be taken regarding the reduction, suspension, or termination of services and/or rights.
For more information:  RICK HASKINS
Keywords: Action Notification, Service Termination, Service Reduction, Rights Suspension, action, notification, change, eligible, eligibility, terminate, terminated, reduced, denied, deny, ineligible, suspension, rights, appeal, Action Notification, Service Termination, Service Reduction, Rights Suspension, Notification of Action to be Taken, Notification of Actions to be Taken.

PCA Host Home Provider Agreement Addendum
This document is an addendum to the Host Home Porvider Agreement; it is addresses the protection of protected health information.
For more information:  JODI WALTERS
Key words: Host Home Provider, Protected Health Information, PHI, HIPAA, confidential information.

Program Request Form - Pre-set with Innovations information
Imagine! program request form for requesting goods and services.  This Excel document has 3 tabs available, each pre-set for the use of Innovations employees.
For more information contact: MATT BARNERT
Key word search: Innovations program request, program, request, voucher, vendor, accounting, approval, check.

Staff Vacation Request Form
Form to be completed to request vacation time for Innovations staff.
For more information contact: MATT BARNERT

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