Main Menu
Forms for DDS
Forms for DDS

Forms for DDS

Adult Foster Home Forms

1:1 Staffing Record (Sample)
Activities Record (Sample)
Application for Employment (Sample)
Aspiration Protocol (Sample)
Balancing Test for Psychotropic Medication (Sample)
Checklist for Adult Foster Care License
Complaint Procedure (Must be posted)
Complaint Resolution Process Transmittal
Constipation Protocol (Sample)
Correcting Documentation Errors
Dehydration Protocol (Sample)
Drug Disposal Record (Sample)
Emergency Phone Number List (Sample)
Emergency Plan (Sample)
Emergency Supply List (FEMA Brochure)
Financial Record and Ledger (Sample)
Fire Evacuation, Smoke and Carbon Monoxide Detector Checks (Sample)
Floor Plan Guidelines
General Protocol (Sample)
Getting your Home Ready for Licensing
Hot Water Can Burn (Oregon Burn Center Brochure) 
Home and Community-Based Services Waiver
House Rules (Sample)
Incident Report
Incident Report for PPI
Medication Administration Record (Sample)
Menu (Sample)
Personal Property Record (Sample)
Physician Visit and Order Form (Sample)
Pica Protocol (Sample)
Provider and Staff Training Log (Sample)
Provider Applicant List of References
Provider Health History and Physician/Nurse Practitioner's Statement
Residency Agreement Form
Resident Bill of Rights (Must be posted)
Resident Record Table of Contents (Sample)
Seizure Protocol (Sample)
Substantiated Abuse Notification Transmittal
Substitute Caregiver Orientation Record (Sample)
Training Requirements Summary
Variance Request Form

Forms Available on the Department of Human Services Website

Child Foster Home Forms

Balancing Test
Child Summary Sheet
Correcting Documentation Errors
Direct Deposit Form
Drug Disposal Form and Instructions
Emergency Exit Orientation
Emergency Phone Numbers (List)
Emergency Supply List (FEMA Brochure)
Evacuation Drill Record
Household Fire Exit Plan
Incident Report Form
Incident Report with PPI Form
Individual Financial Record
Medical Visit Form
Medication Administration Record (MAR)
Medication and TX Orders
Personal Property Record
Progress Notes
Remember the MAR
Resident Bill of Rights
Safety Assessment for Children with Adults Living in the Home
Variance Request Form
Weight Record

Personal Support Worker Forms

eXPRS How to Access and Login for First Time Users
eXPRS How to Reset Your Password
eXPRS User Enrollment Form 
eXPRS User Enrollment Form Instructions
eXPRS Quick Guide for Online Billing System
eXPRS Status Definitions
Mandatory Abuse Reporting for Adults
Mandatory Abuse Reporting for Children
PSW Enrollment Application and Agreement Form
PSW Enrollment Instructions
PSW Job Description DHS Form 0550 
PSW New Provider Enrollment Form

Privacy Practices

Notice of Privacy Practices
Notice of Privacy Practices (Spanish)
Non-Discrimination Notice