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Required forms for placement

Individuals

  • Form-650.E-Initial-Assessment 2025
  • Form-650-Comprehensive-Assessment 2025
  • Form-675 Person Centered Review for DD waiver-2025
  • Form-680-Progress-Note-2025
  • Form-690-Individual-Orientation-Checklist 2025
  • Form-691-Transfer
  • FORM-693-DISCHARGE -2025
  • Items needed for placement
  • Placement Agreement 2025-2026
  • Psychotropic Medication Acknowledgment
  • Form-710-A-Illness-Injury-Crisis-2025
  • Form-720-Fall-Risk-Assessment-2025
  • FORM-750-A-EMERGENCY-MEDICAL-INFO 2025
  • Form-890C-Individual-Record 2025
  • Form-890-Face-Sheet
  • Form-920-Individual-Record-Review 2025
  • Form-920-MAR-Checklist 2025
  • House Rules
  • Resident Room Choice Acknowledgment Form
  • Residential lease agreement
  • Form-80.B Consent to Exchange Info 2025
  • Form-240A-Fee-Determination-2025
  • Form-240A-Fee-Determination-copy
  • Form-240-Financial-Information-Form-Expenses-and-Disbursemen…
  • Form-600-Daily-Nutrition-Monitoring-Form-2025
  • Form-645-B-Initial Contact-Admission 2025

Staff/facility

  • Form-530E-Fire-Drill-Log
  • Form-450.6-STAFF-TRAINING-AND-DEVELOPMENT-2025
  • Form-920-EMPLOYEE-PERSONNEL-RECORDS-CHECKLIST 2025
  • 📝 HCBS and Human Rights Staff Knowledge Test
  • 📝 Human Rights and Incident Reporting Staff Test
  • Form-440-Employee-Orientation 2025
Clark Quality Care, LLC

Providing structured, supportive group home care for children and adolescents with emotional, behavioral, and developmental needs.

  • (757) 776-5280

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