Provider Related Forms

To open a pdf version of the form, click on "PDF"; to open a Word version of the form, click on "Word". 
  • Adult Foster Care (AFC) and Community Residential Setting (CRS) Program Abuse Prevention Plan (PAPP) (DHS-16-180922 6/12/15) (Word) (PDF)
  • Adult Foster Care (AFC) Disaster Plan (71980-182 12/16) (Word) (PDF)
  • Adult Foster Care (AFC) Fire and Tornado Drill Log (71980-240 12/16) (Word) (PDF)
  • Adult Foster Care (AFC) Home Participant's Grievance Policy (71980-166 5/16) (Word) (PDF)
  • Adult Foster Care (AFC) Program Plan - landscape (71980-247 1/19) (Word) (PDF)
  • Adult Foster Care (AFC) Program Plan - portrait (DHS-16-181480 8/18) (PDF)
  • Adult Foster Care (AFC) Request for a Variance (71980-208 2/11) (Word) (PDF)
  • Adult Foster Care (AFC) Training Record (71980-216 2/13) (Word) (PDF)
  • Adult Foster Care (AFC) Program Plan (71980-247 2/20/18) (Word) (PDF)
  • Daily Medication Chart (5/08) (Word) (PDF)
  • Emergency and Non-Emergency Numbers (71980-79 8/15) (Word) (PDF)
  • Foster Care Drug and Alcohol Policy (DHS-306112 8/18) (PDF)
  • Foster Care Emergency Escape Plan (DHS-299698 6/18) (PDF)
  • Foster Home In Use (71980-19 4/12) (Word) (PDF)
  • Grievance Procedures for Adult Foster Care (DHS-306120 8/18) (PDF)
  • MJUA Incident Report Form (PDF)
  • Program Abuse Prevention Plan (PAPP)-AFC (71980-53 4/9/12) Portrait view (Word) (PDF) 
  • Program Abuse Prevention Plan (PAPP)-AFC and CRS (DHS-16-180922 6/12/15) Landscape view (Word) (PDF)
  • VA Report Internal Review (71980-248 8-18) (Word) (PDF)

Background Study Forms:

The directions and access to begin a study will be given to the applicant once a worker has been assigned.

  • AFC Background Study Tracking Form (71980-236 4/16) (Word) (PDF)
  • CFC-AFC-FADS BGS Data Collection Form (DHS 12-14-17) (Word)