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Provider Information & Documents
- For Telephone Notifications: Call (888) 200-1296 toll free or (740)
345-5437
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For Sending Incident Reports and other Monthly documents fax to:
(888) 206-4492 or email to criticalincident@houseofnewhope.org
| 1 hour notification | -Death of a child |
| -Involvement of foster child with law enforcement | |
| -AWOL (after missing for 1 hour) | |
| -Use of Assisted Safety Restraint | |
| 4 hour notification | -Emergency medical treatment |
| -Suspension or expulsion from school | |
| -Alleged delinquent/criminal behavior | |
| -Victim of delinquent/criminal behavior | |
| -Self-harming behavior | |
| -Assault requiring medical intention | |
| -Explicit threat of serious injury | |
| -Change in medication | |
| 24 hour notification | -Critical incident report (form) |
| -Emergency room papers | |
| By the 5th of the Month | Per Diem Invoice |
| fax to: (888) 600-6599 | Mileage Reimbursement |
| Monthly Documentation of Treatment | |
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By the 10th of April, July, |
Child Care Allowance (optional) |
| Respite Care Allowance (optional) | |
| After Special Events | All grade cards and academic achievements |
| fax to: (740) 745-3429 | All medical, optometric, dental and hearing exams |
| At Recertification Time | Pet vaccination documents |
| fax to: (888) 246-0445 | Well water test |
| Home owner's insurance declaration page | |
| Auto insurance declaration page | |
| Driver's License photocopy | |
| 30 days Prior to Major Events | New household occupants |
| fax to: (888) 246-0445 | Marriage |
| Divorce or Separation | |
| Death of a household occupant |
These documents require Adobe Reader. They are not interactive and cannot be typed on or emailed directly from the webpage. You must print the document, complete and fax (or scan and email).
| Allowance and New Clothing Log.................................................................... | |
| Assisted Safety Restraint Debriefing Form...................................................... | |
| Childcare Allowance........................................................................................ | |
| Clothing Inventory Checklist (0-24 months).................................................... | PDF WEB |
| Clothing Inventory Checklist (2-5 years)......................................................... | PDF WEB |
| Clothing Inventory Checklist (6-12 years)....................................................... | PDF WEB |
| Clothing Inventory Checklist (13-18 years)..................................................... | PDF WEB |
| Consent for Travel-Out-Of-County.................................................................. | |
| Dental Exam.................................................................................................... | |
| Emergency Contact and Telephone Numbers.................................................. | |
| Fire Evacuation Plan........................................................................................ | |
| Hearing Exam.................................................................................................. | |
| Incident Report................................................................................................ | PDF WEB |
| Medication Log................................................................................................ | |
| Mileage Reimbursement Form.......................................................................... | |
| Monthly Documentation of Treatment.............................................................. | |
| New Child Placement Guidelines...................................................................... | |
| Optical Exam.................................................................................................... | |
| Per Diem Invoice.............................................................................................. | PDF WEB |
| Physical Exam (Admission & Annual)................................................................ | |
| Physical Exam (Routine).................................................................................. | |
| Placement Agreement..................................................................................... | |
| Placement Agreement Update......................................................................... | |
| Placement Checklist........................................................................................ | |
| Planned Respite Agreement............................................................................ | |
| Receipt of Referral Information........................................................................ | |
| Reimbursement Request................................................................................. | |
| Request to Administer Psychotropic Meds (Cuyahoga County)....................... | |
| Request to Administer Psychotropic Meds (Summit County)............................ | |
| Respite Care Allowance................................................................................... | |
| Respite Care Checklist..................................................................................... | |
| Respite Care Progress Report......................................................................... | |
| Respite Care Information............................................................................... | PDF WEB |
| Respite Information Receipt............................................................................ | |
| Statement of Knowledge Gained..................................................................... | |
| Valuables Inventory........................................................................................ | |
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| INDEPENDENT LIVING SKILLS | |
| I Can Do It! A Micropedia of Living on Your Own | |
| Module 1 - Money, Food and Home Management | |
| Module 2 - Personal Care, Health, Social Skills, and Safety | |
| Module 3 - Education, Job Seeking Skills, and Job Maintenance Skills | |
| Module 4 - Housing, Transportation, Community Resources, Law and Play | |
| Ready, Set, Fly - Parent's Guide to Teaching Life Skills |
TEACHING RACIAL TOLERANCE
| Beyond the Golden Rule |
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Copyright (c) 2010 - All Right Reserved - House of New Hope
House of New Hope, 8135 Mount Vernon Road, St. Louisville, OH 43071, (888) 200-1296