Please view some information on the codes and regulations that we abide by, as well as some support information resources.
Instructions: All documents are latest version and can be downloaded to your computer. The document format cannot be altered; however, it has fields which can be filled for documentation. In case of any question or issue with any document please contact us at (603) 935-7248.
Medical Healthcare Visit Form
Dental Visit Form
Annual Physical Form & Checklist
Medication Review Form
Medication Change Form
Medication Log Form (White: Routine, Pink – PRN)
Medication Log Form (Yellow – Controlled Medications)
Seizure Report Form
Bowel Tracking Form
Health Information Disclosure Authorization Form
Drug Information Sheet
Medication Error Form Fillable
Nursing Medical Tracking Form
NT Annual Review Form
Med Log QA Form
Controlled Med Count Sign Off Sheet
Client Specific Forms
Client’s Monthly Financial Record
Client’s Personal Valuable Record
Incident Report Form & Nursing Medical Intervention Report
Monthly Respite Voucher
Weekly Respite Voucher
CPS Staff Time Sheet
Fire Drill Form
Transition Evaluation Form
Weekly and Monthly Brushing Chart
Food Tracking Journal
Human Services Links
New Hampshire Department of Health and Human Services: Comprehensive portal to all state bureaus, including the Bureau of Developmental Disabilities and Medicaid.
Massachusetts Department of Mental Health: Comprehensive portal to all state bureaus, including the Department of Mental Health and MassHealth.
Disability Rights Center: The Disabilities Rights Center (DRC) is New Hampshire’s designated Protection and Advocacy agency and authorized by federal statute “to pursue legal, administrative and other appropriate remedies” on behalf of individuals with disabilities.
Manchester Community Resource Center: A Manchester-based non-profit offering a variety of education and employment services. Phone# (603) 647-8967.
NH Family Voices: A parent-run organization aimed at connecting families with a network of support and information. Services include a lending library, work shopping, and an expansive resource list. Phone# (603) 271-4255.
Parent Information Center: A Concord-based organization, PIC offers information and support for families, children and educators. Phone# (603) 224-7005.
New Horizons Food Pantry: Manchester-based food pantry offering additional support services. Phone# (603) 668-1877.
Camp Allen: New Hampshire’s premiere camp for individuals with disabilities. (603) 622-8471.
New Hampshire’s Statewide Independent Living Council (SILC): Organization providing leadership and advocacy in support of the independent living philosophy for persons with significant disabilities.
Massachusetts Developmental Disabilities Council: Providing opportunities for people with developmental disabilities and their families to enhance independence, productivity, and inclusion.
Medicare Advantage Plans in New Hampshire: Official web site of Medicare Advantage Program in New Hampshire. General information, enrollment requirements, and contacts are included.