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.

UPDATE the COVID-19 Screening Tool MUST be administered IMMEDIATELY on intake. NO EXCEPTIONS

• Intake Form  ​ 

  • For non specialty homes

  • Parolees​

  • 184 Clients

  • 305 Clients

  • 317 Clients

• Housing First Intake Form  ​

  • Daily Progress Report​

• 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. ​

Forms

• New Patient Behavioral Health Intake Packet

• Re-Entry Court Movement Sheet

• Warning of Non-Compliance

  • Sample Form

• Medication Log​

• Emergency Medical (Print)

• 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

• Confidentiality Agreement

NBH

• NBH Intake Form (Rev. 10, 2020)  ​​

• Safe Bed Intake Form

• Safe Bed Discharge Form

​

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!

Service Fees

If your resident is in arrears on their service fees, they will typically receive an email from the accounting department and will be required to complete the following form.  A copy of the form will be forwarded to the House Manager and you will be asked to monitor the clients financial obligation

• Budget Form

• Promissory Note

​

​

​

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

​

​

​

• Resume Worksheet​

• Training Tools

​

​

Donations

Workforce Development