Form 06AC069E "Review of Policies and Areas of Responsibilities" - Oklahoma

What Is Form 06AC069E?

This is a legal form that was released by the Oklahoma Department of Human Services - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 23, 2021;
  • The latest edition provided by the Oklahoma Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 06AC069E by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Human Services.

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Download Form 06AC069E "Review of Policies and Areas of Responsibilities" - Oklahoma

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Page background image
Review of Policies and
Areas of Responsibilities
Agency Companion Provider
Specialized Foster Care Provider
Agency Companion Policy Review
Yes
No
317:40-5-3 Agency Companion Services and 317:40-5-40
Utilizing and providing respite relief
Room and board/consumer contribution
Revocation of approval for failure to comply with policies/procedures
Yes
No
317:40-5-5 Agency Companion Services provider responsibilities
Responsibilities to support family, friend, and other community connections
Responsibility to provide active treatment/documentation, teamwork,
planning, IDT/IP participation
Arranging appropriate transportation
Responsibility to serve as Health Care Coordinator and gather annual
assessments
Confidentiality
Unannounced home visits may be made by DDS staff
Respecting individual's rights including privacy and freedom of religion
Report allegations of abuse/neglect/mistreatment are referred to and
investigated by the appropriate agency
Yes
No
317:40-5-13 Agency Companion Services provider agency responsibilities
Utilizing substitute caregivers
The provider immediately reports to the FC Specialist all changes in the
household
Notice prior to moving a consumer
340:100-5-32 Medication administration
Yes
No
Proper storage of medications
Documentation of medications and medical appointments
Disposal of discontinued drugs
Use of PRN medications
340:100-5-57.1 Reporting and monitoring the use of restrictive or intrusive
Yes
No
procedures or emergency interventions
Behavior supports
Yes
No
340:100-3-4 Service recipient personal funds
Management of service recipient personal funds
Yes
No
340:100-3-12 Prohibition of client abuse
Abuse/neglect
06AC069E
8/23/2021
Page 1 of 2
Review of Policies and
Areas of Responsibilities
Agency Companion Provider
Specialized Foster Care Provider
Agency Companion Policy Review
Yes
No
317:40-5-3 Agency Companion Services and 317:40-5-40
Utilizing and providing respite relief
Room and board/consumer contribution
Revocation of approval for failure to comply with policies/procedures
Yes
No
317:40-5-5 Agency Companion Services provider responsibilities
Responsibilities to support family, friend, and other community connections
Responsibility to provide active treatment/documentation, teamwork,
planning, IDT/IP participation
Arranging appropriate transportation
Responsibility to serve as Health Care Coordinator and gather annual
assessments
Confidentiality
Unannounced home visits may be made by DDS staff
Respecting individual's rights including privacy and freedom of religion
Report allegations of abuse/neglect/mistreatment are referred to and
investigated by the appropriate agency
Yes
No
317:40-5-13 Agency Companion Services provider agency responsibilities
Utilizing substitute caregivers
The provider immediately reports to the FC Specialist all changes in the
household
Notice prior to moving a consumer
340:100-5-32 Medication administration
Yes
No
Proper storage of medications
Documentation of medications and medical appointments
Disposal of discontinued drugs
Use of PRN medications
340:100-5-57.1 Reporting and monitoring the use of restrictive or intrusive
Yes
No
procedures or emergency interventions
Behavior supports
Yes
No
340:100-3-4 Service recipient personal funds
Management of service recipient personal funds
Yes
No
340:100-3-12 Prohibition of client abuse
Abuse/neglect
06AC069E
8/23/2021
Page 1 of 2
Signatures
I attest that the above policies were explained to me and I have been informed of how to find these
policies online.
Applicant/provider signature
Date
Spouse/other adult signature
Date
SFC/ACS signature
Date
06AC069E
8/23/2021
Page 2 of 2
Page of 2