NOTICE * NOTICE * NOTICE * NOTICE * NOTICE

• INTAKES MUST be complete within 48 hours of residents arrival

• DISCHARGE MUST be complete within 24 hours of residents departure

• If you find any errors or inconsistencies please notify the form developer - Sandy@LifeChangesInc.org.

• Intake Form  ​ 

  • For non specialty homes

  • Parolees​

  • 184 Clients

  • 305 Clients

  • 317 Clients

• Housing First Intake Form  ​

• Sliding Fee Schedule Worksheet  

  • For Step Out home ONLY!

• Discharge Form

• Lease Agreement

  • This is ONLY for residents that may need a lease agreement due to an outside source of payment. ​

NBH

• NBH Intake Form (Rev. 10, 2020)  ​​

• Safe Bed Intake Form

• Safe Bed Discharge Form

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NOTE: These forms are ONLY to be used for residents that are utilizing a NBH bed.  If you are unsure if your clients is from NBH PLEASE reach out to Lisa!

• New Patient Behavioral Health Intake Packet

• Re-Entry Court Movement Sheet

• Warning of Non-Compliance

  • Sample Form

• Medication Log​

• Release of Information

  • Sample Form

• Promissory Note​

  • Sample Form

• Meeting Sheets

  • For Print

• Sign In/Out Sheets​

  • For Print

• Case Notes​

• Photo Taker

• Supply List

Donations

Donation receipts allow Life Changes to track the value of community support and provides a tax deduction for the donor. The information on this form allows administrative staff access to the required information for documentation.

• Donation Receipt

Workforce Development

• Resume Worksheet​

• Training Tools