Service Delivery Documentation Templates
DODD has put together documentation templates for providers. While these forms are not required, providers do need to ensure their service delivery documentation includes all required elements.
All providers are required to maintain service delivery documentation.
Providers need to ensure they are using the correct documentation template for the service they are providing. Documentation also must include the description and details of the services delivered that relate to the services and supports identified in the plan to be provided. This includes documenting both supports and outcome/action steps.
DODD will continue to make templates for additional services available.
Stark DD Monitoring Specialist, Kristen Moon, is able to assist with questions about provider documentation, templates, paper/electronic documentation, and the aspects of compliance as they relate to providers.
Kristen can be reached at 330-479-3648 or DocumentationSupport@starkdd.org.
Stark DD Housing Specialist, Larry Beckwith, is able to assist with questions about residential lease agreements, landlords renting to individuals served by Stark DD, and the aspects of compliance as they relate to providers.
Larry can be reached at 330-479-3476 or HousingSupport@starkdd.org.
Incident Report Form
Use this form to report and track usual or major unusual incidents.
An unusual incident or UI, is an event or occurrence involving a person that is not consistent with routine operations, policies, and procedures, or the person's care or service plan, but is not a major unusual incident.
Major unusual incidents or MUIs, are alleged, suspected, or actual occurrences of an incident when there is reason to believe the health and welfare of a person may be adversely affected or the person is placed at a likely risk of harm.
Unusual Incident Report Log
Every independent and agency provider must maintain a log of Unusual Incidents or UIs.
Both independent and agency providers must review UI logs at least once per month to ensure appropriate preventive measures were implemented and to identify patterns or trends.
Reporting and tracking these incidents supports providers to understand trends and patterns to help ensure health and safety.
View Form
MUI Annual Report for Independent Providers Template
This template offers independent providers a tool to support ongoing analysis of major unusual incidents, or MUIs. MUIs should be reviewed and analyzed for patterns and trends annually.
MUI Annual Report for Agency Providers Template
This template offers provider agencies a tool to support ongoing analysis of major unusual incidents, or MUIs. MUIs should be reviewed and analyzed for patterns and trends annually.