• DHS 0305
  Residents' Bill of Rights 
   
  
• DHS 7262H
  Direct Deposit Form - SPD Provider  

• DHS 9030 
  AFH Caregiver Preparatory Training - Study Guide


• DHS 9030W
  AFH Caregiver Preparatory Training - Workbook


• MSC 0944
  Adult Foster Home Provider Complaint Form

• SDS 0305A
  Residents' Bill of Rights - for signature
   
  
• SDS 0306
  Adult Foster Home Weekly Menu
   
  
• SDS 0340
  AFH Care Plan
   
  
• SDS 0340A
  Adult Foster Home Guide to Writing Care Plans
   
  
• SDS 0341
  Medical Visit Report
   
  
• SDS 0342
  AFH Fire Drill and Evacuation Record
   
  
• SDS 0342A
  Documentation of Resident Orientation to Home
   
  
• SDS 0344
  AFH Incident Report Form

• SDS 0346
  AFH Resident Personal Possessions

• SDS 0347
  AFH Classification Exception Request
   
  
• SDS 0349
  Substitute Caregiver Orientation Record 
   
  
• SDS 0419B
  Resident/Legal Representative's Authorization to Release Confidential Information
   
  
• SDS 0448
  Adult Foster Home Initial License Application
   
  
• SDS 0448A
  Adult Foster Home Financial Information
   
  
• SDS 0448B
  Adult Foster Home Supplemental Application
   
  
• SDS 0448C
  Adult Foster Home License Renewal/Capacity Change Application
   
  
• SDS 0490
  Special Needs Resident Admission Review
   
  
• SDS 0511F
  Fire and Life Safety in Adult Foster Homes
 

• SDS 0514A
  Exception Request Worksheet (payment exception)
   
  
• SDS 0516
  AFH Initial Inspection
   
  
• SDS 0517
  AFH Inspection Worksheet (this form is being revised)
   
  
• SDS 0518
  Important Telephone Numbers (for posting) 
  
  
• SDS 0519
  AFH Complaint Procedure and Fair Housing Notice
   
  
• SDS 0713
  Resident Account Record 
   
  
• SDS 0812A
  Medication Administration Record (PRN) 
   
  
• SDS 0901
  Adult Foster Home Notice of Resident Move, Transfer or Discharge
   
  
• SDS 0902
  General Information and Screening Assessment 
   
  
• SDS 0902A
  Emergency Contact Information
   
  
• SDS 0903
  Health History and Physician / Nurse Practitioner's Statement
   
  
• SDS 0906N
  Monitoring Device Notice (Available through Forms Branch Ordering System (FBOS) Only)
  There should be a designated person in each DHS office who is responsible for ordering forms through this system.
   
  
• SDS 0913
  Notice of Right to Receive a Long-Term Care Assessment
   
  
• SDS 1510
  Request for AFH Training Credit - Instructor's or Sponsor's Form
   
  
• SDS 1513
  Request for AFH Training Credit - AFH Provider Form
 

Note: If you have a disability and need a document on this Web site to be provided to you in another format, please send an email to dhs.forms@state.or.us or call the Office of Communication Resources (OCR) at 503-378-3486, for TTY call 503-378-3523. If you know of others who need this accommodation, please let them know it is available

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