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For Providers

Relicensing Forms- Community Residential Services

Application for corporations (PDF)
Worker’s compensation form (PDF)
Relicensing Review of Home (DOC)
Current Residents List (PDF)
Pet Verification (PDF)
Employee List (PDF)

Relicensing Forms- AFC with NO HCBS license

Application for Family AFC (PDF) OR Application for Corporate AFC (PDF)
Worker’s compensation form (PDF)
List of Current Residents (DOC)
Residents for Last 5 Years (DOC)
Program Plan (PDF)
Relicensing Review of Home (DOC)
Fire Safety & Pet Verification (DOC)
Employee List (DOC)
 

Forms Only for Homes with Mental Health Certification:

Adult Mental Health Certification Request & Recommendation form (PDF)
Adult Mental Health Certification Attachment A (PDF)
Adult Mental Health Certification Attachment B (PDF)


General Forms

New Resident Placement form (DOC)
Resident Discharge Form (DOC) 

Fire Drill Guidelines & Log (PDF)
Employee Quarterly Report (DOC)
Floor & Escape Plan (PDF)
Family Provider Floor & Escape Plan (PDF)



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  1. Stevens County
    400 Colorado Avenue
    Morris, MN 56267

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