Individual's NameOrientation DateIntake DateTeam Member AssignmentParticipant Handbook ReceivedYesNoI have received information about the followingPolicies and ProceduresRights and ResponsibilitiesGrievance and Appeal ProceduresSpecial Policies Participant/Individual Input and OutcomesProgram Services, Activities and Class SchedulesHours of Operation, Expected level of ParticipationOn-Call ServicesCode of EthicsConfidentiality PoliciesDischarge Follow Up RequirementsPolicy on Restraint and SeclusionTobacco Products/ Smoking AreasFinancial Obligations, Fees and Financial ArrangementsPolicy on Weapons Brought to the ProgramHIPPAPolicy on Illicit Drugs or Alcohol at the Progrd!llTour of the FacilityEmergency Exits/SheltersEmergency EvacuationFire Suppression EquipmentFirst Aid Procedures and SuppliesAreas of facility for personal/group/and clinical useReview of Program RulesReview of Program, and Agency RulesReview of Discharge and Suspension PoliciesPersonal Property on the premises or in VehiclesEducation RegardingAdvanced DirectivesAssessment ProceduresDevelopment of the Person-Centered PlanTransition and Discharge Criteria and PlanningMedication Use and MonitoringIdentification of Primary Team Member for Service CoordinationUniversal PrecautionsHIV, and other Bloodbome PathogensAvailability of CPR and first Aid classesClass and Group ChoicesParticipants 'governing body and how to provide input and suggestionsDate *Type Full Name *Participant Signature *Your browser does not support e-Signature field.Date *Team Member SignatureSubmit FormPlease do not fill in this field.
