Family and Social Services Administration
BQIS Resource Materials
Assistive Supports and Therapies
- Basic Human Needs (Non Graphics Version) OR-FM-AS-MS-61
- Body Mass Index Table OR-FM-AS-WG-64
- Fall Assessment Form (At time of Fall - IDT Rev) OR-FM-AS-FL-65
- Fall Risk Assessment Checklist & Intervention Plan OR-FM-AS-FL-66
- Making the Most of Therapy Appts OR-FM-AS-TA-68
- Mobility Screening Instructions & Definitions OR-FM-AS-ML-67
- Mobility Screening for Low Vision or Blind OR-FM-AS-ML-70
- Positioning Plan Protocol (Sample)OR-FM-AS-PS-74
- Positioning Competency-Based Training Checklist OR-FM-AS-PS-71
- Positioning Plan Protocol (Blank Form) OR-FM-AS-PS-62
- Positioning Schedule Format (Blank Form) OR-FM-AS-PS-63
- Positioning Schedule (Sample) OR-FM-AS-PS-75
- Skin Assessment (Revised) OR-FM-AS-PU-73
- TIS Wheelchair Maintenance & Safety Checklist OR-FM-AS-ML-76
- Water Temp Adjustment Assessment OR-FM-AS-MS-77
- WC Checklist for Power Maintenance and Safety OR-FM-AS-ML-72
- WC Manual for Maintenance and Safety Checklist OR-FM-AS-ML-69
Lifespan Development
- Client Profile (Blank Form) OR-FM-LD-MS-82
- Client Profile (Example) OR-FM-LD-MS-83
- Client Profile (Sheet Directions) OR-FM-LD-MS-81
Mental Health
- Psychiatric Consultation Questionnaire OR-FM-MH-PT-84
- Psychiatric Symptoms Form OR-FM-MH-PT-85
Health and Safety
Constipation
- BM Tracking Sheet OR-FM-HS-CN-10
- Bowel Aid Food Recipes OR-FM-HS-CN-12
- Bristol Stool Form Scale OR-FM-HS-CN-15
- Constipation Protocol OR-PR-HS-CN-02
- Hospital Contact Record OR-FM-HS-MA-105
Dehydration
- Dehydration Protocol OR-PR-HS-DH-03
Dental
- Dental Exam and Treatment Record OR-FN-HS-DT-22
- Dental Exam OR-FN-HS-DT-23
Dining
- Dining Plan (Blank) OR-FN-HS-DN-24
- Dining Plan (Sample) OR-FN-HS-DN-25
Dysphagia
- Choking Risk Assessment OR-FM-HS-DY-16
- Dysphagia Fact Sheet (Blank)
- Dysphagia Fact Sheet (Example)
- Dysphagia Competency (Based Training Checklist) OR-FN-HS-DY-26
- Dysphagia Plan Monitor OR-FN-HS-DY-27
Dysphagia Risk Level Indicators
- Dysphagia Trigger Tracking Sheet OR-FN-HS-DY-29
- Pneumonia Risk Assessment OR-FN-HS-DY-49
GERD
- GERD Protocol OR-PR-HS-GD-05
Health Assurance
- Annual Health Screening Recommendations OR-FM-HS-HA-80
- Comprehensive Healthcare Assessment OR-FN-HS-HA-18
- Health Assurance Review Guide OR-FM-HS-HA-02
Managing Appointments
- Appointment Form Carey Services OR-FM-HS-MA-09
- Demographic Sheet Carey Services OR-FN-HS-MA-21
- Health Appointment Folder Carey Services OR-FN-HS-MA-32
- Health Care Practitioner Encounter Form OR-FN-HS-MA-33
- Health Record Carey Services OR-FN-HS-MA-34
- Health Record Form OR-FM-HS-MA-03
- Health Review Checklist OR-FN-HS-MA-35
- Medical Appointment OR-FM-HS-MA-05
- Medical Consultant Record OR-FN-HS-MA-39
- Medical Intake form St. Vincent Jennings OR-FN-HS-MA-40
- Medication History Form OR-FN-HS-MA-41
- Monthly Health Review OR-FN-HS-MA-42
- Procedure for Medical Appointment OR-FN-HS-MA-51
- Quarterly Healthcare Update OR-FN-HS-MA-53
Miscellaneous Health and Safety
- Competency based Instructions OR-FN-HS-MS-17
- Flow Record Instructions OR-FN-HS-MS-30
- Flow Record OR-FN-HS-MS-31
- Mealtime Competency (Based Training Checklist) OR-FN-HS-MS-38
- Oral Care & Med Pass Competency (Based Training Checklist) OR-FN-HS-MS-44
- Progress Note OR-FN-HS-MS-52
- Sleep Chart OR-FN-HS-MS-54
- Sleep Record OR-FN-HS-MS-55
- Water Temperature Adjustment Assessment OR-FN-HS-MS-57
Nutrition
- Daily Food Intake OR-FN-HS-NU-20
- Feeding Tube Protocol
- Intake and Output OR-FN-HS-NU-36
- Intake Sheet Blank OR-FN-HS-NU-37
- Physical Nutritional Management Plan Format OR-FN-HS-NU-48
- Physical Nutritional Management Plan Sample OR-FN-HS-NU-47
Pain Management
- Pain Data Sheet OR-FN-HS-PN-45
- Pain Scale (Sample) OR-FN-HS-PN-46
Pressure Ulcer
- Braden Scale OR-FM-HS-PU-13
- Braden Scale Risk Levels OR-FM-HS-PU-14
- Pressure Sore Data Collection OR-FN-HS-PU-50
Risk Plan
- Risk Plan Sample OR-FM-HS-RP-07
- Risk Plan Template with Instructions OR-FM-HS-RP-06
- Risk Plan Template OR-FM-HS-RP-04
Saliva Management
- Drooling Measures Form OR-FM-HS-SM-78
- Getting Hands Out of the Mouth Handout OR-HA-HS-SM-06
- Getting that Tongue Going Handout OR-HA-HS-SM-09
- Getting Lips Together & Working Handout OR-HA-HS-SM-08
- Helping your Child to Feel the Saliva Handout
- Helping Your Child Dry Chin Handout OR-HA-HS-SM-07
- Saliva Control Assessment Form OR-FM-HS-SM-79
- Surgery for Saliva Control Handout OR-HA-HS-SM-04
- Use of Artane Handout OR-HA-HS-SM-01
- Use of Botox Handout OR-HA-HS-SM-02
- Use of Glycopyrrolate Handout OR-HA-HS-SM-03
Seizures
- Annual Seizure Summary Form OR-FM-HS-SZ-08
- Diastat Adult Admin OR-HA-HS-SZ-10
- Diastat Protocol OR-PR-HS-SZ-04
- Observation of Seizure Pattern OR-FN-HS-SZ-43
- Seizure Protocol OR-PR-HS-SZ-06
- VNS Protocol OR-PR-HS-SZ-07
Vital Signs
- Vital Sign Recording Form OR-FN-HS-VS-56
Weight
- Body Mass Index Table OR-FM-HS-WG-11
- Weight Sheet Example OR-FN-HS-WG-59
- Weight Sheet OR-FN-HS-WG-58
- Weight Tracking Sheet OR-FN-HS-WG-60
DDRS Outreach Services Contents
Online Services
Top FAQs I Want To...
- Apply for or check the status of my Medicaid (health coverage), SNAP (food assistance) or TANF (cash assistance) benefits.
- Find a quality child care provider in my local area.
- Learn about home and community-based supports for the elderly.
- Learn about job assistance for people with disabilities.
- Seek help for a mental health issue or a drug, alcohol or gambling addiction.
