C: DHHS Assisted-Living Service Provider Addendum, HCB Waiver for Aged Persons, Adults or Children with Disabilities (MILTC-1AD)

Appendix C Developing Goals in Outcome Measurement

I reserve the right to discharge any resident whose personal care needs change for more than a temporary time period to a level beyond the service capability of this facility.

In instances where a person must be discharged from the facility, I agree to work with the Services Coordinator to allow time for alternative services arrangements to be made.


Signatures

I have read and understand the above statements and agree to meet them while providing Waiver Assisted Living Services.


Sign Here
Faculty Administrator Date


I have explained the above statements to this provider, and This Assisted Living Facility meets all of the standards to provide Waiver Assisted Living Service.


Sign Here
Waiver Representative Date