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Forms/Manuals Download Section
 
Web Links:
Click Here to Visit the New York State Website Click Here to Visit the OASAS Website Click Here to Visit the OMH Website
 
Formset Overview: The New York State Clinical Records Initiative (NYSCRI) lead to the creation of a standardized set of clinical record forms that can be used by outpatient, day, and residential programs (for both adults and children)  which are regulated by the New York State Office of Alcoholism and Substance Abuse Services and the New York State Office of Mental Health. These standardized forms will provide more uniformity for provider staff, improve documentation, facilitate movement between various levels of care as well as reduce the investment in maintaining records over time. This site contains downloadable program specific forms, manuals and support materials which can be used by participating providers.
 
Home and Community Based Waiver Program

Download Key:

Paper: Please utilize this link to access the Adobe PDF® version of the form for those members who will be printing the forms and entering information manually by hand.

E-Form: Please utilize this link to access the Microsoft Word® version of the form for those members who will be entering information into the forms electronically.

Manual
: Please utilize this link to access the support manual specific to this form.

Full Section One Training Manual
Revision Date: 11-25-10

Core Forms Paper E-Form Manual
 
Personal Information
Revision Date: 4-7-11
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Personal Information Update
Revision Date: 11-25-10
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Child/Adolescent CA
Revision Date: 1-6-11
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Child/Adolescent CA Update
Revision Date: 11-25-10
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Individualized Action Plan (IAP)
Revision Date: 1-6-11
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Individualized Action Plan - Additional Goal Sheet
Revision Date: 11-25-10
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IAP Review/Revision
Revision Date: 4-8-11
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Discharge Summary/Plan 
Revision Date: 11-25-10
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Pre-Admission Note
Revision Date: 11-25-10
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Screening/Admission Note
Revision Date: 4-5-11
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Contact Note
Revision Date: 11-25-10
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Coordination of Care Note
Revision Date: 11-25-10
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Group Note
Revision Date: 11-25-10
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Assessment Addendums Paper E-Form Manual
 
Legal Involvement and History Addendum
Revision Date: 11-25-10
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  Legal Status  Addendum
Revision Date: 11-25-10
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  Employment Assessment Addendum
Revision Date: 11-25-10
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  Mental Status Exam Addendum
Revision Date: 11-25-10
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  Military Addendum Full Length
Revision Date: 11-25-10
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  Military Addendum Significant Others
Revision Date: 11-25-10
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  Risk Assessment Addendum
Revision Date: 11-25-10
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Substance Use Addendum
Revision Date: 11-25-10
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NYS Waiver Forms
Additional OMH Forms  for HCBS Waiver: These are available on the OMH Web Site
  1. Home  and Community Based Services Waiver Safety Alert Plan (SAP) - Rev 8/10
  2. Home  and Community Based Services Waiver Safety Plan Contract - Rev. 5/10 
  3. Child  and Adolescent Needs and Strengths (CANS-MH)
  4. Level  of Care - Form 907 MED (MH) (7-98)
  5. Home  and Community Based Services Application for Participation and Freedom
of  Choice
- Last Modified 5/12/2008
  6. Result  of Screening - Last Modified 5/28/2008 
  7. Home  and Community Based Services Financial Information Form 
  8. Service  Plan Budget 
  9. Use  of Flex Funds - Last Modified 6/19/2009
  10. Home  and Community Based Services Waiver Discharge Plan
- Last  Modified 1/25/2007
  11. Home  and Community Based Services Waiver Aftercare Follow-Up Plan 
 
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