Minnesota Dhs Form PDF Details

Navigating the intricacies of providing intensive supports and services in Minnesota requires compliance with numerous policies and procedures, as outlined by the Minnesota Department of Human Services (DHS) Licensing Division. At the heart of ensuring quality care and legal compliance for 245D licensed providers are the critical policies and forms developed to guide the operation of residential and service programs. These materials, ranging from emergency use of manual restraint policies to drug and alcohol prohibition, grievance procedures, and vulnerable adult maltreatment reporting, are essential tools in the management and administration of care. Providers are tasked with the adaptation of these sample policies and forms to create a tailored operational blueprint that aligns with the unique needs of their services while adhering to the stringent requirements of 245D licensing. The required policies and procedures, along with an array of forms for documenting everything from incident reports to medication administration and emergency medical authorizations, underscore the comprehensive approach Minnesota takes towards safeguarding the health, safety, and rights of service recipients. Beyond mere compliance, these policies and forms serve a dual role as a framework for best practices in the delivery of intensive supports and services, emphasizing the importance of a personal-centered approach in achieving positive outcomes for individuals under care. With an effective date for development set and samples made available, providers are equipped to meet statutory obligations and enhance the quality of care delivered, reflecting the dedication of the Minnesota DHS to uphold the highest standards of service provision and recipient protection.

QuestionAnswer
Form NameMinnesota Dhs Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names245d policies and procedures, dhs 245d forms, 245d licensing, 245d licensing checklist

Form Preview Example

Minnesota Department of Human Services

Licensing Division

Sample Policies and Forms for Intensive Supports and Services

245D licensed providers may link to the sample policies and forms below and modify them for use in their programs. Providers are responsible for ensuring any policy and forms they use meet the 245D licensing requirements, including the samples provided. Read the applicable statute sections or rule parts to ensure you understand the requirements.

 

 

 

 

 

 

Required policies and procedures

 

Applicable MN statute or rule

Date of last

 

 

 

 

revision

 

 

 

 

 

 

 

 

 

 

Required Policies and Procedures

 

 

 

 

 

 

These policies are required at time of application for providers who do not hold a 245B license.

 

 

 

 

 

 

 

Drug and Alcohol Prohibition Policy

 

245A.04, subd. 1(c)

10/31/2013

 

 

 

 

 

 

Emergency Use Of Manual Restraint (EUMR) Policy

 

245D.06, subd. 1(a); 245D.06,

10/31/2013

 

 

 

subd. 5; & 245D.061, subd. 9

 

 

 

 

 

 

 

Grievance Policy

 

245D.10, subd. 2

10/31/2013

 

 

 

 

 

 

Maltreatment Of Minors Reporting and Internal Review Policy

 

245A.66 and 626.556

10/31/2013

 

 

 

 

 

 

Service Suspension And Termination Policy

 

245D.10, subd. 3

10/31/2013

 

 

 

 

 

 

Vulnerable Adults Maltreatment Reporting and Internal Review Policy

 

245A.65, subd. 1(a) and (b) &

10/31/2013

 

 

 

626.557, subd. 4a

 

 

 

 

 

 

Required Policies and Procedures

 

 

 

 

 

 

 

 

All policies must be developed by January 1, 2014.

 

 

 

 

 

 

 

Admission Criteria Policy

 

245D.11, subd. 4

10/31/2013

 

 

 

 

 

 

Data Privacy Policy

 

245D.11, subd. 3

10/31/2013

 

 

 

 

 

 

Emergency Response, Reporting and Review Policy

 

245D.11, subd. 2; 245D.02, subd.

10/31/2013

 

 

 

8; 245D.22, subd 4-7

 

 

 

 

 

 

 

Health Service Coordination and Care (Residential Programs) Policy

 

245D.11, subd. 2(2)

10/31/2013

 

 

 

 

 

 

Incident Response, Reporting and Review Policy

 

245D.11, subd. 2(7); 245D.02,

10/31/2013

 

 

 

subd. 11; 245.91, subd. 6;

 

 

 

 

609.341, subd. 3 and 14

 

 

 

 

 

 

 

Safe Medication Assistance and Administration Policy

 

245D.11, subd. 2(3)

10/31/2013

 

 

 

 

 

 

Safe Transportation Policy

 

245D.11, subd. 2(4)

10/31/2013

 

 

 

 

 

 

Universal Precautions and Sanitary Practices Policy

 

245D.11, subd. 2(1)

10/31/2013

 

 

 

 

 

Required Policies And Procedures for Community Residential Settings and Day Services Facilities

 

 

 

 

 

 

 

 

All policies must be developed by January 1, 2014. Samples will be available in July and August 2014.

 

 

 

 

 

 

 

Program Abuse Prevention Plan (PAPP)

 

245A.65, subd. 2 (a) & 245A.65,

10/31/2013

 

 

 

subd. 2 (a)

 

 

 

 

 

 

Documentation Requirements – Optional Program Forms

 

 

 

 

 

 

 

 

 

45 Day Meeting Summary

 

 

10/31/2013

 

 

 

 

 

 

Admission and Discharge Register form

 

 

10/31/2013

 

 

 

 

 

1

Revised 10/31/2013

Minnesota Department of Human Services

Licensing Division

Assessment Results for Intensive Support Services

 

10/31/2013

 

 

 

Emergency Report and Internal Review Form

 

10/31/2013

 

 

 

Fire Drill Log

 

10/31/2013

 

 

 

Funds and Property Authorization

 

10/31/2013

 

 

 

Health Needs Change Notice

 

10/31/2013

 

 

 

Health Needs Record

 

10/31/2013

 

 

 

Incident Report and Internal Review

 

10/31/2013

 

 

 

Individual Abuse Prevention Plan (IAPP) Form

245A.65, subd.2(b) & 626.6557,

10/31/2013

 

subd. 14

 

 

 

 

HCBS Incident Reporting Requirements - Who to Notify Form

 

10/31/2013

 

 

 

HCBS Service Recipient Rights Packet

 

10/31/2013

 

 

 

HCBS Service Recipient Rights Restrictions

 

10/31/2013

 

 

 

Intensive Support Services Assessment

 

10/31/2013

 

 

 

Medication Administration and Emergency Medical Authorization

 

10/31/2013

 

 

 

Medication Administration Review Record

 

10/31/2013

 

 

 

Medication and Treatment Administration Packet

 

10/31/2013

 

 

 

Medication Setup Record

 

10/31/2013

 

 

 

Person-Centered Planning and Service Delivery Requirements

 

10/31/2013

 

 

 

Progress Review Report for Intensive Support Services

 

10/31/2013

 

 

 

Psychotropic Medication Use and Monitoring Record

 

10/31/2013

 

 

 

Quality Management Evaluation and Program Improvement Plan

 

10/31/2013

 

 

 

Release of Information Authorization

 

10/31/2013

 

 

 

Satisfaction Evaluation

 

10/31/2013

 

 

 

Service Admission Checklist for Intensive Services

 

10/31/2013

 

 

 

Service Recipient Information Cover Sheet

 

10/31/2013

 

 

 

Service Recipient Record Checklist

 

10/31/2013

 

 

 

Service Suspension or Termination for Intensive Support Services Checklist

 

10/31/2013

 

 

 

Staff Orientation and Training Packet

 

10/31/2013

 

 

 

Support Team Meeting Summary

 

10/31/2013

 

 

 

Supports and Outcome Methods for Intensive Support Services

 

10/31/2013

 

 

 

2

Revised 10/31/2013

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1. The 245d application involves particular details to be entered. Ensure that the next blank fields are finalized:

A way to complete dhs 245d forms stage 1

2. Once your current task is complete, take the next step – fill out all of these fields - Safe Medication Assistance and, Safe Transportation Policy, Universal Precautions and Sanitary, D subd D subd subd subd and, D subd, D subd, D subd, Required Policies And Procedures, Program Abuse Prevention Plan PAPP, A subd a A subd a, Documentation Requirements, Day Meeting Summary, Admission and Discharge Register, and Revised with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part no. 2 for filling out dhs 245d forms

3. Completing Assessment Results for Intensive, Emergency Report and Internal, Fire Drill Log, Funds and Property Authorization, Health Needs Change Notice, Health Needs Record, Incident Report and Internal Review, Individual Abuse Prevention Plan, A subdb subd, HCBS Incident Reporting, HCBS Service Recipient Rights, HCBS Service Recipient Rights, Intensive Support Services, Medication Administration and, and Medication Administration Review is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

dhs 245d forms writing process described (stage 3)

Regarding Intensive Support Services and Medication Administration Review, be sure that you double-check them here. The two of these are the most significant fields in this PDF.

4. The fourth section arrives with these fields to fill out: Medication and Treatment, Medication Setup Record, PersonCentered Planning and, Progress Review Report for, Psychotropic Medication Use and, Quality Management Evaluation and, Release of Information, Satisfaction Evaluation, Service Admission Checklist for, Service Recipient Information, Service Recipient Record Checklist, Service Suspension or Termination, Staff Orientation and Training, Support Team Meeting Summary, and Supports and Outcome Methods for.

Writing part 4 of dhs 245d forms

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