Residential/Consumer Record

Residential service providers must have a chart for each resident in their facility. A “blue book” can initially be obtained from the placing service coordinator or from your facility liaison. This book contains many of the forms that are to be used to document information about a consumers progress, and medical and financial records. These sample forms can be printed and used “as is” or adapted to suit your facility’s purposes.

Click on the Portable Document Format (pdf) icon to view the form. Click on the WORD document icon to open and save the form for your personalization.

	Board & Care Payment Ledger
	Centrally Stored Medication & Destruction Record
	Checklist for Consumer Documentation
	Client/Resident Personal Property & Valuables
	Consent for Release of Information
	Directions for Consumer Health Record
	Face Sheet
	Handling of Consumer Funds Held in Trust
	Height & Weight Record
	IPP and Progress Reporting
	Medical Visit Record
	Medication Administration Instructions
	Medication Administration Record
	On-Going Consumer Notes
	Physician's Report for Community Care Facilities
	Quarterly Progress Report (Level 2)
	Quarterly Progress Report (Level 3)
	Record of Client's/Resident's Safeguard Cash Resources
	Rights of Individuals with Developmental Disabilities
	Seizure Record
	Special Incident Report	N/A