These easily adaptable administrative and clinical forms are companions to the policies and procedures. These are templates to assist your organization in implementing the BAAS policies and procedures.

To make it easy, Bay Area Accreditation Services made sure the companion administrative forms and clinical forms you will need are referenced at the bottom of the last page of each policy. Be sure to order all the forms you need! If you have questions, please contact us.

 

1.    Administrative and Service Environment (ASE)
2.    Behavior and Support Management (BSM)
3.    Client Rights (CR)
4.    Ethical Practice (EP)
5.    Financial Management (FM)
6.    Governance (GOV)
7.    Human Resource Management (HRM)
8.    Performance and Quality Improvement (PQI)
9.    Risk Prevention and Management (RPM)
10.  Training and Supervision (TS)

11.  Adoption Study (AS)
12.  Comprehensive Behavioral Health Assessment (CBHA) (Florida Only)
13.  Outpatient Mental Health Service (OMHS)

View Sample Policies:

sample policy 1sample policy 2


1. Administrative and Service Environment
a. Form - The Americans with Disabilities Act Checklist Document $15
b. Form - Fire Drill/Fire – Smoke Event Critique Document $10
c. Form – Weekly Maintenance Office Checklist Document $10



2. Behavior and Support Management
a. Form - Behavior Support and Management Statement Training Document $10
  b. Form - Behavior Support and Management Service Information for the Client/Family/Legal Guardian Document (See CR Forms)  
  c. Form - Staff Assessment Behavior Support and Management Questionnaire Document (See PQI Forms)  



3. Client Rights
a. Form - Client Grievance Document $10
b. Form - Client Information: Client Rights Document $10
c. Form - Client Information: Client Rights Child Version Document $10
d. Form - Client Information: Grievance Document $10
e. Form - Client Information: Notice of Privacy Practices Document $10
f. Form - Client Information: Behavior Support and Management Document $10



4. Ethical Practice
a. Form - Conflict of Interest Employee Signature Document $10



5. Financial Management
a. Format - Financial Management Function Organizational Chart $10
  b. Format - Annual Internal Assessment and Evaluation of Risk to the Organization (See RPM Forms Section)  
c. Format - Service Cost Analysis $10
  d. Format - Strategic Plan (See GOV Forms Section)  
  e. Format - SWOT Analysis (See GOV Forms Section)  



6. Governance
a. Format - Governing Board Meeting $10
b. Format - Community Advisory Board Meeting $10
c. Format - Community Advisory Board Bylaws $50
d. Form - Community Advisory Board Confidentiality Agreement Document $10
e. Format - Strategic Plan $50
f. Format - SWOT Analysis $10
g. Format – Annual Report $50
h. Format – Wage and Salary Analysis $10
i. Format - Employment Pattern Analysis $10
j. Format - Annual Insurance Needs Assessment $10
  k. Format - Annual Internal Assessment and Evaluation of Risk to the Organization (See RPM Forms Section)  
  l. Form - Annual Performance Evaluation for Independent -Clinical and Non Clinical - Contractor Document (see PER Forms Section)  



7. Human Resource Management
a. Form – Interview Questionnaire and Worksheet Document $15
b. Form – New Employee Job Description for Counselor Document $15
c. Form – New Employee Hours Documentation and Pay Document – Exempt $10
d. Form – New Employee Hours Documentation and Pay Document – Non Exempt $10
e. Form – New Employee Child Abuse Reporting Acknowledgement Document $10
f. Form – New Employee Condition of Employment Document $10
g. Form – New Employee Confidentiality Agreement Document $10
h. Form – New Employee EEO Designation Document $10
i. Form – New Employee Equal Employment Opportunity Document $10
j. Form – New Employee Family Member Reference Investigation Document $10
k. Form – New Employee Personal Non-Family Reference Investigation Document $10
l. Form – New Employee Professional Reference Investigation Document $10
m. Form – New Employee Personal Information Document $10
  n. Form – New Employee Conflict of Interest Signature Document (See ETH Forms Section)  
o. Form - Annual Performance Evaluation for Independent Contractor Document (Cinical) $15
p. Form – Annual Performance Evaluation for Independent Contractor Document (Non-Cinical) $15
q. Form – Annual Performance Evaluation for Counselor Document $15
r. Form – Employee Counseling Corrective Action Document $10
s. Form – Termination Summary and Exit Interview Document $10
t. Form – Employee Policy and Procedure Table of Contents $10
u. Format - Community Demographic Profile $10
v. Format – GAP Analysis $10
w. Format – Retention Analysis (Excel) $10
  x. Format – Wage and Salary Analysis (See GOV Forms Section)  
  y. Format – Employment Pattern Analysis (See GOV Forms Section)  
z. Form – Statement of Employee Rights and Responsibilities Document $10



8. Performance and Quality Improvement
a. Form – Client Satisfaction Survey Document $15
b. Form – Annual Employee Behavior Support and Management Needs Survey Document $15
c. Form – Annual Employee Education Needs Assessment Survey Document $15
d. Form – Annual Employee Satisfaction Survey Document $15
e. Form - Individual Client Information and Education PQI Monitoring Tool Document $10
f. Form - Individual Client Satisfaction PQI Monitoring Tool Document $10
g. Form - Individual Clinical Review PQI Monitoring Tool Document $10
h. Form - Monthly Client Information and Education PQI Summation Document $10
i. Form - Monthly Client Satisfaction PQI Summation Document $10
j. Form - Monthly Clinical Review PQI Summation Document $10
k. Format – Annual PQI Dashboard Client Information and Education (Excel) $10
l. Format – Annual PQI Dashboard Client Satisfaction (Excel) $10
m. Format – Annual PQI Dashboard Clinical Review (Excel) $10
n. Format – PQI Corrective Action Plan (The CAP) $10



9. Risk Prevention and Management
a. Format - Annual Internal Assessment and Evaluation of Risk to the Organization $50
b. Form - Authorization for Release of Information – From the Agency Document $10
c. Form - Authorization for Release of Information – To the Agency Document $10
  d. Form - Client Information: Notice of Privacy Practices Document (See CR Forms Section)  
e. Form - Consent to Treatment Document $10
f. Format – Monthly RPM Dashboard (Excel) $10
g. Format – Quarter # 1 RPM Dashboard (Excel) $10
h. Format – Quarter # 2 RPM Dashboard (Excel) $10
i. Format – Quarter # 3 RPM Dashboard (Excel) $10
j. Format – Quarter # 4 RPM Dashboard (Excel) $10
k. Format – Annual RPM Dashboard (Excel) $15 $10
  l.Form – Annual Performance Evaluation for Independent Contractor Document (Clinical) (See PER Forms Section)  
  m. Form – Annual Performance Evaluation for Independent Contractor Document (Non-Clinical) (See PER Forms Section)  



10. Training and Supervision
a. Form - New Employment Orientation Checklist Document $10



11. Adoption Study
a. Form - Adoption Child Study Assessment Tool Document $50
b. Form - Adoption Home Study Application Document $25
c. Form - Home Study Assessment Tool Document $50
d. Form - Adoption Home Study Employment Reference Document $10
e. Form - Adoption Home Study Non- Relative Reference Questionnaire Document $10
f. Form - Adoption Home Study Relative Reference Questionnaire Document $10
g. Form – Adoption Home Study School Reference Questionnaire Document $10
h. Form - Adoption Home Study Release of Information/Consent to Adoption Home Study Document $10



12. Comprehensive Behavioral Health Assessment
a. Form – CBHA Consent to Speak with Parents Form Document $10
b. Form – CBHA Consent to Speak with Parents Form Document (Spanish Language) $10



13. Outpatient Mental Health Services
a. Form - In-depth New Client Assessment 4-18 Document $50
b. Form - In-depth New Client Assessment 18+ $50
c. Form - Chemical Dependency Psychosocial Assessment Document $10
d. Form - Mental Health Treatment Plan Document $25
e. Form - Family Therapy Progress Note Document $10
f. Form - Group Therapy Progress Note Document $10
g. Form - Individual Therapy Progress Note Document $10
h. Form - Aftercare Care Plan Document $10
i. Form - Treatment Case Closing Document $10
  j.Form - Consent to Treatment Document (See RPM Forms Section)  
  k. Form - Authorization for Release of Information – From the Agency Document (See RPM Forms Section)  
  l. Form - Authorization for Release of Information – To the Agency Document (See RPM Forms Section)