Required Documents

As a provider you are required to maintain certain documentation to ensure your continued certification. Below are a SOME of the required documentation for a provider. Depending on your certification your requirements may be different. If you have questions please contact the Provider Relations Manager, Sherrie Simmons at ssimmons@coshdd.org.

DOCUMENTATION FORM

Documentation Form: Per DODD rule and Medicaid Requirements you will need to complete a daily documentation sheet. This is a DODD form that has all of the required elements. You will find the “description of services” that you are responsible for throughout Discovery and the ISP.

Documentation Form

MUI ANALYSIS FORM

MUI Analysis Form will need to be completed annually in January and sent to Bambi Zinkon. (bzinkon@coshdd.org). Contact Bambi with any questions.

Agency Form

Independent Form

UNUSUAL INCIDENT LOG

Unusual Incident Log Review Form- Must be completed monthly EVEN IF there are no UIRs that month.

UI log

8 HOUR ANNUAL TRAINING

8 hour annual training that includes the following elements: MUI, Rights, Behavior Support, Self Determination, Person Centered Planning and Community Integration.

VALID CPR/FIRST AID

ACTION PLAN(S) & LEARNING LOGS (ENTER IN IS SYSTEM)

Action Plan & Learning Log Info