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\nFORMS BOOK  \nTABLE OF CONTENTS  \nSection 1: Telephone Intake Forms  \n• Phone Call Inquiry Form – version 1, 2, 3, 4  \n• Phone Inquiry Follow-up Letter  \nSection 2: Practice Information Forms  \n• Code of Ethics & Standards of Practice  \n• Client Responsibilities Overview  \n• Clients’ Rights and Responsibilities  \n• Statement of Goals  \n• Mission Statement Template  \n• Statement of Confidentiality Template  \nSection 3: Sample Service Agreements & Releases  \n• Disclaimer from ALCA Legal Counsel  \n• Care Management Service Agreement – version 1  \n• Care Management Service Agreement – version 2  \n• Care Management Service Agreement – version 3  \n• Care Management Service Agreement – version 4  \n• Care Management Service Agreement – version 5  \n• Email Consent Template  \n• Medicaid Service Agreement  \n• Medicaid Representative Template  \n• Authorization for Release of Confidential Information  \n• Sample HIPAA Release Form  \n• Audio/Visual Release Form  \nSection 4: Initial Assessment Forms  \n• Introduction  \n• Family Questionnaire – version 1  \n• Family Questionnaire – version 2  \n• Initial Assessment Family Questions  \n• Aging Life Care Assessment Guidelines  \n• Assessment Tool  \n• Assessment: Activities of Daily Living  \n• Assessment: Emotional Health Supports  \n• Assessment Form – version 1  \n• Assessment Form – version 2  \n• Assessment Form – version 3  \n• Assessment Form – version 4  \nSection 5: Dementia Assessment Tools & Forms  \n• Dementia/Depression Assessment Form  \n• Depression Assessment Form  \n• Mental Health Assessment Form  \nSection 6: Specialized Assessment Tools & Forms  \n• Get-up and Go Test  \n• Barthel Index of Activities of Daily Living  \n• Instrumental Activities of Daily Living (IADL)  \n• Fulmer Elder Abuse & Neglect Assessment  \n• Performance-Oriented Assessment of Gait  \n• Lawton Instrumental Activities of Daily Living Scale  \n• Hoarding Questionnaire  \n• Safety Assessment  \n• Home Safety Assessment Form  \n• Urinary Diary Instructions and Tracking Sheet  \n• Addiction/Alcoholism Test  \n• CAGE Assessment for Alcohol Abuse  \n• Safety Risk Scale  \n• Fall Risk Assessment Form  \n• Social Assessment  \n• Sample Caregiver Daily Record  \n• Care Conference Worksheet  \n• Discharge Check List  \n• Hospital Assessment Check List  \nSection 7: Care Planning Forms  \n• Plan of Care Template  \nSection 8: Client Visit Report Forms  \n• Client Visit Report Form  \nSection 9: Completion of Case/Termination Forms  \n• Case Closing Summary Template  \n• Case Closed Form  \n• Termination Summary Form  \n• Case Closing Summary Form  \nSection 10: Employee Forms  \n• Incident Form  \n• Mileage/Expense Log  \n• Time Sheet Template  \n• Petty Cash Record Form  \n• Consult and Communications Log  \n• Non-solicitation Agreement Form  \n• Employment Application Form  \n• Equipment Loan to Employee Form  \n• Emergency Contact Form  \n• Emergency Preparedness for Aging Life Care Managers  \n• Power Outage Precautionary Check Off List  \n• Facility Evaluation Form  \n• Psych Therapy Intake Form  \n• Consent to Services Form  \nAppendix: State Specific Forms, Sample Assessments & Tools, Articles and Charts  \n• Durable Health Care Power Attorney & Health Care Treatment Instructions – State of PA  \n• POLST Assessment – State of FL  \n• Montreal Cognitive Assessment (MOCA)  \n• VAMC: SLUMS Examination  \n• Mini Mental State Examination (MMSE)  \n• Global Deterioration Scale (GDS) Dementia Assessment Form  \n• Dementia Behavioral Assessment Tool  \n• Patient Health Questionnaire (PHQ-9) Form  \n• Pain Assessment in Advanced Dementia Scale (PAINAD) Form  \n• Bristol Stool Chart  \n• Determine Your Nutritional Health  \n• American Geriatric Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults  \n• I9 Employment Verificati","cbCaimxLM63BIeKZ","https://ap.wps.com/l/cbCaimxLM63BIeKZ","pdf",190460,"English","# Section 1: Telephone Intake Forms\n# Section 2: Practice Information Forms\n# Section 3: Sample Service Agreements & Releases\n# Section 4: Initial Assessment Forms\n# Section 5: Dementia Assessment Tools & Forms\n# Section 6: Specialized Assessment Tools & Forms\n# Section 7: Care Planning Forms\n# Section 8: Client Visit Report Forms\n# Section 9: Completion of Case/Termination Forms\n# Section 10: Employee Forms\n# Appendix: State Specific Forms, Sample Assessments & Tools, Articles and Charts","[{\"question\":\"What forms are included for telephone intake?\",\"answer\":\"Section 1 lists a Phone Call Inquiry Form (versions 1–4) and a Phone Inquiry Follow-up Letter.\"},{\"question\":\"What does Section 3 cover regarding agreements and releases?\",\"answer\":\"Section 3 includes legal counsel disclaimers, multiple versions of the Care Management Service Agreement, an email consent template, Medicaid service documents, HIPAA and other release authorizations, and audio/visual release options.\"},{\"question\":\"What is the purpose and legal framing of the Forms Book?\",\"answer\":\"The book states the materials are offered as sample forms “as is,” not as an endorsement or recommendation, and it disclaims warranties and liability; members are responsible for ensuring suitability for their specific situation.\"}]","Aging Life Care Association Forms Book - Table of Contents - July 2024 | PDF",1790129715]