FORMS
TRAINING REGISTRATIONS:   Independent Provider Certification Information:
Monthly MUI Training Independent Provider Initial Certification Application Process
Bi-Monthly Being an Independent Provider Training Clearwater COG MUI Training
New Provider Certification Training Summary Northwest Ohio Waiver Administration Council Training
  Ohio Association of County Boards Training
    Application for Supported Living HCBS Waiver Provider Certification
Clearwater Wave Awards   Declaration Regarding Material Assistance Nonassistance to a Terrorist Organization
Clearwater Wave Award Nominations   Ohio Health Plans Provider Enrollment Application Time Limited Agreement for Individual Practitioners
Medication Side Effects   Provider Certification Application Addendum Transportation Mileage Other Than To Access Adult Day Services
2010 COG Quality Management Report   Provider Certification Application Addendum Homemaker Personal Care
Benefit Planning Query Handbook   Provider Certification Application Addendum Informal Respite
Social Security Administration Resources   Provider Certification Application Addendum Transportation
COG Specialty Areas   Vendor Information Form
    W-9
Creative Day Services and Electronic Monitoring    
    Skill Development Individual Program Plan
QA Forms    
   Quality Assurance Report   Behavior Support Information
   ISP and BSP Compliance    
   Individual Response to Service and Support Administration   Basic Agency Information
   Limited/Short-term/Level 1 Quality Assurance Report    
   Adult Day Support and Vocational Habilitation QA Review Agency Provider Training Requirements
   Supported Employment Enclave and Community QA Review    
   File Review Checklist   Individual Provider Training Requirements
      
QA Surveys   Free Choice of Provider Flowchart
   Service and Support Administrator Survey    
   Residential Provider Survey   Delegated Nursing and Medication Administration Certification
   Family/Guardian Survey    
   Daily Representative Survey   Comparing Service Providers
     
Medication Administration   MUI Contacts
  Medication Administration and Health Related Activities Form    
  Blank Self-Administration Assessment Form - General   MUI Report Form
  Blank Self-Administration Assessment Form - G/J Tube    
  Blank Self-Administration Assessment Form - Glucometer   MUI Rule Training
  Blank Self-Administration Assessment Form - Insulin Injections    
  Notification of Referral   Waiver Transfer Protocol
  Family Delegation Form  
  Documentation Requirements
Financial Documentation Tips  
Individual Inventory Record Documentation Templates
Individual Gift Card Account  
Individual Funds Transaction Record Documentation Required Elements
  Documentation Helpful Hints
Day Services Monitoring Tool  
Universal Monitoring Tool Provider Training Certificate Requirements
Universal Monitoring Tool (with duplicated pages)  
Universal Monitoring Tool (limited services)  
   
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