AFC Forms Inventory

Cross-reference of binder sections with PDF files. Click links to view PDFs.

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Has PDF Missing PDF Extra PDF (not in TOC)

Section 1: Demographics

Form	PDF File	Notes
Client ID / Photo / SSN	PROPOSED: client-id-page.html	Combined ID, Photo, SSN page
Client Data / Emergency Contact	PATIENT EMERGENCY AND CONTACT INFORMATION.pdf
Client Insurance Check	PROPOSED: insurance-verification.html	Combined verification form
Client MassHealth Card	-	Copy in client-id-page
Client Referral Form	PROPOSED: referral-form.html	Intake form
Client Initial Application	MEMBER APPLICATION.pdf

Section 2: Prior Authorization

Form	PDF File	Notes
Primary Care Provider / Annual	Official MassHealth PCP Order Form	Download from Mass.gov
PA Request (MassHealth)	MASSHEALTH MEMBER.pdf
PA Approval Letters	-	From payers
MD Consultation Report	MD CONSULTATION REPORT.pdf	Supports PA requests

Section 3: Authorizations / Agreements

Form	PDF File	Notes
Medical Release of Information	AUTHORISATION FOR RELEASE OF MEDICAL INFORMATION.pdf
Authorization for PHI	AUTHORISATION FOR USE AND DISCLOSURE...
Consent for Services	CONSENT FOR SERVICES AND FINANCIAL AGREEMENT.pdf
Authorizations and Agreements	AUTHORIZATION, AGREEMENT AND ACKNOWLEDGEMENT.pdf
HIPAA Privacy Rights	ADVANCE DIRECTIVE ACKNOWLEDGEMENT HIPAA...
Client Rights and Responsibilities	CLIENTS RIGHTS AND RESPONSIBILITIES.pdf
Client Information Handbook	CLIENT INFORMATION HANDBOOK.pdf
Post Admission Survey	POST ADMISSION SURVEY.pdf
Telehealth Consent	TELEHEALTH CONSENT ACKNOWLEDGEMENT.pdf
AFC Funding Agreement	AFC FUNDING AGREEMENT.pdf
AFC Grievance and Appeal Rights	AFC GRIEVANCE AND APPEAL RIGHTS.pdf
Non-Discrimination Policy	NON-DISCRIMINATION POLICY.pdf
Consent for Care Services	CONSENT FOR CARE SERVICES.pdf	RN admission packet
Written Consent for Release	WRITTEN CONSENT FOR RELEASE OF INFORMATION.pdf	Additional consent
Release of Liability	RELEASE OF LIABILITY.pdf	Additional consent
Release of Responsibility	RELEASE OF RESPONSIBILITY.pdf	Additional consent
Provider/Client Agreement	PROVIDERS AND CLIENT AGREEMENT FOR SERVICES.pdf	Additional agreement
MassHealth Permission to Share	MASSHEALTH-PERMISSION TO SHARE INFORMATION.pdf	MassHealth-specific
Acknowledgment of Privacy Practices	ACKNOWLEDGMENT OF RECEIPT OF PRIVACY...	Additional acknowledgment
Patient Bill of Rights	PATIENTS BILL OF RIGHTS.pdf	Goes with Rights section
Patient Rights and Responsibilities	PATIENTS RIGHTS AND RESPONSIBILITIES.pdf	Variant of above

Section 4: Medical

Form	PDF File	Notes
TB Screening (PPD/X-Ray)	TUBERCULOSIS SCREENING FORM.pdf
Physical / Medical Record	MEDICAL SHEET.pdf
Medication List (Annual)	PROPOSED: medication-list.html	Annual medication review

Section 5: Care Plans

Form	PDF File	Notes
MDS-HC (Annual)	MINIMUN DATA SET-HOME CARE (MDS-HC).pdf	5-page assessment
Plan of Care (all types)	PLAN OF CARE.pdf	Used for 5-day, 30-day, annual, semi, level change, etc.
Care Plan Task Sheet	CARE PLAN TASK.pdf	Daily task checklist

Section 6: Case Management

Form	PDF File	Notes
Home Alone Assessment	HOME ALONE ASSESSMENT.pdf
Home Assessment	ADULT FOSTER CARE HOME ASSESSMENT FORM.pdf
Psychosocial Assessment	MEMBER PSYCH-SOCIAL ASSESSMENT.pdf
Home Safety Assessment (EN/ES)	HOME SAFETY ASSESSMENT... (Bilingual)	Bilingual variant
Home Inspection	HOME INSPECTION.pdf	Physical inspection
Patient Home Evaluation	PATIENT HOME EVALUATION.pdf	Home suitability
Home Safety Check + Progress Notes	HOME SAFETY CHECK AND PROGRESS NOTES.pdf	Combined form
Member Safety Assessment	ADULT FOSTER CARE PROGRAM MEMBER SAFETY...	Safety-specific
Pre-Admission Meeting Form	PRE-ADMISSION MEETING FORM.pdf	Pre-admission
Pre-Admission Assessment	ADULT FOSTER CARE(AFC) PRE-ADMISSION ASSESSMENT.pdf	Screening
Evaluation/Re-Evaluation Visit	EVALUATION,RE-EVALUATION OR SERVICE AGREEMENT VISIT.pdf	Reassessments

Section 7: Daily Logs

Form	PDF File	Notes
Caregiver Flowsheets	PROPOSED: caregiver-daily-log.html	Weekly ADL/IADL tracking
Care Plan Task Sheet (daily use)	CARE PLAN TASK.pdf	Also in Care Plans

Section 8: Safety

Form	PDF File	Notes
Fire Exit Plan	FIRE EXIT PLAN.pdf
Fire Safety Plan	AFC FIRE SAFTEY PLAN.pdf
Emergency Action Plan	EMERGENCY ACTION PLAN.pdf
Emergency Disaster Plan	EMERGENCY-DISASTER INFORMATION...
Client Evacuation Plan	CLIENT EVACUATION PLAN PROCEDURE.pdf
Fire Drill Report	FIRE DRILL REPORT( STATE THE MONTH).pdf	April/October
Emergency Evac - Full Plan	EMERGENCY EVACUATION AND SAFETY PLAN.pdf	Combined plan
Emergency Evac - Caregiver Portion	...CAREGIVER PORTION.pdf	Caregiver section
Emergency Evac - Caregiver Ack	...ACKNOWLEDGEMENT.pdf	Caregiver signs
Emergency Evac - Alternate Placement	...ALTERNATE PLACEMENT.pdf	Backup placement
AFC Emergency Evaluation Plan	AFC EMERGENCY EVALUATION PLAN.pdf	Emergency eval
Yearly Fire Drill	YEARLY FIRE DRILL.pdf	Annual variant

Section 9: Incident Report / Discharge

Form	PDF File	Notes
Incident Report	INCIDENT REPORTING.pdf
Discharge/Transition Plan	DISCHARGE-TRANSITION LAN.pdf
Post Discharge Status	POST DISCHARGE STATUS AND CONDITION.pdf	Outcome tracking
Member Transfer Form	MASSHEALTH ADULT FOSTER CARE MEMBER TRANSFER FORM.pdf	For transfers

Section 10: Nursing Notes

Form	PDF File	Notes
Nurse Narrative	NURSE NARRATIVE.pdf
ER Sheet	ER SHEET.pdf	ER visit documentation
ER/Unplanned Hospitalization	EMERGENCY ROOM AND UNPLANNED HOSPITALISATION...	Hospital tracking

Section 11: Caseworker Notes

Form	PDF File	Notes
Caseworker Notes Template	PROPOSED: caseworker-notes.html	SOAP format progress notes
Home Safety Check + Progress Notes	HOME SAFETY CHECK AND PROGRESS NOTES.pdf	Combined form

Section 12: Miscellaneous (Supporting Forms)

Form	PDF File	Supports Section
Request Form (to Doctor)	PROPOSED: request-to-physician.html	Fax cover + request
Physician Verbal/Written Orders	PHYSICIAN -VERBAL WRITTEN ORDERS.pdf	Medical (4)
Physician Summary Form	PHYSICIAN SUMMARY FORM.pdf	Medical (4)
Face to Face Encounter	PHYSICIAN FACE TO FACE ENCOUNTER FORM.pdf	Medical (4), PA (2)
AFC Leave Day Policy	AFC LEAVE DAY POLICY.pdf	Ongoing Care
Lost or Missing Person Protocol	LOST OR MISSING PERSON PROTOCOL.pdf	Incidents (9)
AFC MHEC Change of Address	AFC MHEC CHANGE OF ADDRESS.pdf	Demographics (1)
AFC DTA Change of Address	AFC DTA CHANGE OF ADDRESS.pdf	Demographics (1)
AFC SSA Change of Address	AFC SSA CHANGE OF ADDRESS.pdf	Demographics (1)
Policies and Procedures	POLICIES AND PROCEDURES.pdf	All
Alternate Care Policy	ALTERNATE CARE POLICY.pdf	Care Plans (5), Safety (8)
Alternate Caregiver Request Form	ALTERNATE CAREGIVER REQUEST FORM.pdf	Events: Caregiver Change
Community Resources	COMMUNITY RESOURCES.pdf	Case Management (6)
Client Admission Checklist	CLIENT-ADMISSION CHECK LIST.pdf	Admission tracking
COVID-19 Questionnaire (EN/ES)	COVID 19 QUESTIONNAIRE-CUESTIONARIO COVID-19.pdf	Admission, Visits
Front Page	FRONT PAGE.pdf	Binder cover
Top Aid Healthcare Inc	TOP AID HEALTHCARE, INC.pdf	Company info

Summary

Category	Count
Forms with PDFs	~85
Missing PDFs (need to create/obtain)	~10
Extra PDFs (variants/supporting)	~30

Proposed Forms Created

Section 1: Client ID/Photo/SSN Page, Insurance Verification, Referral Form
Section 2: PCP Order Form (Official)
Section 4: Medication List
Section 7: Caregiver Daily Log/Flowsheet
Section 11: Caseworker Notes (SOAP format)
Section 12: Request to Physician

View Complete Workflow

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Generated for TopAid AFC v3 - Last updated: January 2026