Skip to content
About MPC
Our Services
Our Providers
Patient Forms
Clinical Referral
About MPC
Our Services
Our Providers
Patient Forms
Clinical Referral
Get Help Now
Participant Orientation Form
Individual's Name
Orientation Date
Intake Date
Team Member Assignment
Participant Handbook Received
Yes
No
I have received information about the following
Policies and Procedures
Rights and Responsibilities
Grievance and Appeal Procedures
Special Policies Participant/Individual Input and Outcomes
Program Services, Activities and Class Schedules
Hours of Operation, Expected level of Participation
On-Call Services
Code of Ethics
Confidentiality Policies
Discharge Follow Up Requirements
Policy on Restraint and Seclusion
Tobacco Products/ Smoking Areas
Financial Obligations, Fees and Financial Arrangements
Policy on Weapons Brought to the Program
HIPPA
Policy on Illicit Drugs or Alcohol at the Progrd!ll
Tour of the Facility
Emergency Exits/Shelters
Emergency Evacuation
Fire Suppression Equipment
First Aid Procedures and Supplies
Areas of facility for personal/group/and clinical use
Review of Program Rules
Review of Program, and Agency Rules
Review of Discharge and Suspension Policies
Personal Property on the premises or in Vehicles
Education Regarding
Advanced Directives
Assessment Procedures
Development of the Person-Centered Plan
Transition and Discharge Criteria and Planning
Medication Use and Monitoring
Identification of Primary Team Member for Service Coordination
Universal Precautions
HIV, and other Bloodbome Pathogens
Availability of CPR and first Aid classes
Class and Group Choices
Participants 'governing body and how to provide input and suggestions
Date
*
Type Full Name
*
Participant Signature
*
Your browser does not support e-Signature field.
Date
*
Team Member Signature
Submit Form
Please do not fill in this field.
