Aug 21, · Adult Family Homes: Forms. Assisted Living Facility Request for Waiver, Approval, Variance or Exception, F; Resident Evacuation Assessment, F (PDF) Fire Reporting. All . ADULT FAMILY HOME LICENSE APPLICATION. Page 5 of 5. DSHS (REV. 0 4/) Section Applicant Certification Signature. I certify, under the penalty of perjury under the laws of the State of Washington and by my signature, that the information provided in this application and all additional documents and forms .
The following is a summary of the rights of individuals living in licensed long-term care facilities (adult family homes, boarding homes and veteran’s homes) in the state of Washington. This summary is . Adult Family Home Program Statement Adult Family Home Individualized Service Plan Form Adult Family Home Member Keyed Bedroom Door Policy Adult Family Home Member Physical Exam Report Adult Family Home ( Bed) Member Placement Packet Adult Family Home .
Announcements. Safe Start for AFH-ALF-ESF. RCS Reimplementation of Inspection and Investigation Activity (POSTPONED). Latest Guidance Regarding COVID See provider letters for the latest . These forms are intended as samples only. Please review and modify the forms to reflect the needs of your residents. AFH providers are responsible for providing resident care according to State and .