Adult Family Homes -
Forms
Introduction | Rules_&_Regulations
| Forms | Providers
|
Contacts | Publications
| Related Sites
For questions regarding adult family homes, you may
contact the Bureau of Assisted
Living, Division of Quality Assurance (attention the Bureau of Assisted
Living).
The first two items are fillable PDF forms - select the first field
to begin typing. Tab from field to field. You can print this
document but you cannot save it.
-
F-62548
(PDF, 17 KB): Assisted Living Facility Request for Waiver, Approval, Variance or
Exception
-
F-62500
(PDF, 11 KB): Fire Report form - To report fires in a facility.
-
F-62373
(PDF, 35 KB): Resident Evacuation
Assessment
- Fire
Report form DQA F-62500 (Word, 78 KB) - Fillable form with
contacts to assist the reporting of fires in a healthcare facility.
- Fire Watch memorandum DQA
12-013 - Outlines the minimum procedures for when a required
sprinkler or fire alarm system is out of service.
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Last Updated: August 21, 2012 |
