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Contents
Applicant Forms
- Code of Conduct for Custodians of People with Special Needs
- LDSS-2865 - Application for Approval Family-Type Home for Adults
- LDSS-3239 - Medical Evaluation (Operator)
- LDSS-4388 - Fire/Safety Inspection Report: Word LDSS-4388 | PDF LDSS-4388
- LDSS-4505 - Family-Type Home for Adults Certification of Child Support Obligations
- LDSS-7014 - Personal History of Applicant Family-Type Home for Adults
- LDSS-7016 - Emergency Plan
Clearance Forms
- LDSS-3370 - Statewide Central Register Database Check
- LDSS-3370-S - Instrucciones para Completar el Formulario de Verificación de Datos del Registro Central del Estado
- OCFS-6070 - Request for Staff Exclusion List Check: Word OCFS-6070 | PDF OCFS-6070
Operator Forms
- LDSS-2853 - Statement Offering Personal Allowance Account
- LDSS-2854 - Personal Allowance Register
- LDSS-2949 - Personal Data Sheet: Word LDSS-2949 | PDF LDSS-2949
- LDSS-2855 - Personal Allowance Summary
- LDSS-3026 - Chronological Admission and Discharge Register: Word LDSS-3026 | PDF LDSS-3026
- LDSS-3027 - Inventory of Residents Property Held by Facility for Safe Keeping
- LDSS-3123 - Incident Report (DARC)(DAS)
- LDSS-3633 - Individual Resident Fund Record Account
- LDSS-3634 - Resident Medication Record
- LDSS-3635 - Medication Log
- LDSS-3705 - Special Needs Fund Individual Resident Log
- OCFS-3122 - Family-Type Home for Adults-Medical Evaluation (Resident)
- OCFS-3913 - Residents Special Needs Expenditure Log
- OCFS-3914 - Health and Safety Equipment and Substitute Care Expenditure Log
- OCFS-4258 - Application for Hospice: Word OCFS-4258 | PDF OCFS-4258