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provider resources

The following forms and documents are being made available to providers and others in the community. They are intended to describe agency procedures in some matters, and also to provide easy access to forms which are frequently used by providers. Please click on the link that you wish to view:

These Behavior support service (BSS) documents describe FCBDD policies and also provide forms which may commonly be used by providers who provide behavioral intervention to FCBDD-eligible persons.
Revised Behavior Support Procedures Manual
Behavior Support Plan (BSP) Training Documentation Form
Behavior Support Plan Quick Reference Form (QRF)

This shortened version of the FCBDD Nursing Handbook is made available to providers, families and others to provide an overview of agency medical policy and practices.
Nursing Handbook (short form)

These medical forms are completed by/for new applicants and are updated by current enrollees when requesting transfers or as needed by their respective facilities.
General Medical Form
General Medical Update Form

These documents are required for adult services applicants, and are the same for all facilities/ services unless otherwise noted.
Referral Documentation Requirements Document

This form is completed by the home provider for a participant who has been absent and recovering from a significant medical event or injury.
Release to Return to Work Form

This request form is completed by/ for any adult who is currently enrolled at one of the adult service facilities and is requesting onsideration for placement at another within the family of FCBDD programs.
Request for Transfer Procedures

This vocational form is used to describe work background and preferences of the person seeking services.
Work Experience Reference Document

This form is completed by/ for any new adult applicant (including students transitioning from schools) seeking services from FCBDD. It is part of the initial intake process and if there is an assigned service coordinator, he/she can assist with its completion.
Application for Adult Services

This form is a form of the Ohio Department of Developmental Disabilities (DODD) to report incidents or Major Unusual Incidents (MUIs). Providers should verbally report Major Unusual Incidents to the MUI Department at 614-464-2743. Incident report forms can be faxed to the MUI Department at 614-342-5593. If questions, providers or others can contact the MUI Department by calling 614-464-2743.
DODD Incident (MUI) Form

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Franklin County Board of Developmental Disabilities
2879 Johnstown Road | Columbus, OH 43219
PH 614-475-6440 | FAX 614-342-5001