Member Rights and Responsibilities Resources

• The Right to Risk
• The Right to Refuse
• The Right to Make Choices
• The Right to Participate
• Participation
• Partnership
• Ownership
• Communication
• RAD
• Dignity of Risk
• Tell Me More
• Personal Property
• Citizen Worksheet
• Rights as Citizens

Other Forms & Resources

• Adult Family Home Program Statement
• Adult Family Home Individualized Service Plan Form
• Adult Family Home Member Keyed Bedroom Door Policy
• Adult Family Home Member Physical Exam Report
• Adult Family Home (1-2 Bed) Member Placement Packet
• Adult Family Home (1-2 Bed) Service Agreement
• Authorization to Dispense Medications Form
• Certification Handbook (1-2 Bed) Adult Family Home
• Long Term Care Functional Screen Summary and Scoring Guide
• Family Care and Family Care Partnership Differences & Resources
• Medication Administration Record
• Medication Information Sheet
• Member Absence Notification Form – Residential (Online Submission)
• Member Lookup Administrator Application Form
• Member Monthly Cash Log
• Member Notification Form – Nursing Home
• Member Notification Form – Nursing Home (Online Submission)
• Member Rights & Responsibilities
• Provider Contact Information and Updates
• Provider Incident Report Form
• Provider Incident Report Quick Guide
• Provider Incident Report Training (PDF Presentation)
• Provider Incident Report Training (Online Course)
• Rehab Agency Therapy Cover Sheet
• Residential Provider Request for Long Term Care Functional Screen Form
• Residential Provider Vacancy Reporting
• Release of Information Form
• Residential Provider Update Form
• Signing the Member Centered Plan
• Therapy Cover Sheet Form

Please submit forms to the address listed on the form. If no address is listed, please submit to ProviderRelations@inclusa.org