Important Links
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- Email Exchange
- HR Check
- City of Springfield Database
- Employee Assistance
- Program Service Contact Sheet
- MHA Employee Handbook
- Whistleblower Policy 2016
Employee Documents
Please click on the headings below to expand and select documents
- Authorization for Ongoing Two-Way Communication
- Authorization to Request Protected Health Information
- Consent for Media Release
- Consent to Receive Prescribed and/or Psychotropic Medications
- Management of Funds Consent
- Medical Services and Hospital Emergency Consent
- Medical Services Refusal Form
- Notice of Privacy Practices
- Routine and Preventative Medical Care Consent
- APG Time Card Non-exempt
- APG Time Card Professional and Managerial
- ATM Card Usage Agreement
- ATM Purchases
- Contingency Request Form CHD
- DDS Charges for Care Guidelines
- DDS Charges for Care Agreement
- Direct Deposit Authorization
- Disposal of Assets Request Form
- DMH Charges for Care Guidelines
- Equipment Asset Approval Form
- Financial Transaction Record With Daily Balance Count
- Management of Funds Consent
- MHA-APG Prenotification Movement Form
- Representative Payee Advocacy Agreement
- Rep Payee Check Request Form
- Representative Payee Monthly Finance Plan
- Representative Payee Services Fee Agreement
- Request to Access Participant Funds
- Request to Amend Monthly Finance Plan
- Requisition Form ATM Purchase Loan to Participant
- Request for Pay In Lieu Of Time (PILOT)
- Requisition Voucher
- Staff Mileage Form
- Stop Payment Request Form
- Tenant Movement Notification Form
- Time Card – Non-Exempt
- Time Card – Professional and Managerial
- Updated Change of Status
- Use of Cell Phone Agreement
- User Access Request Form June 2016
- Vehicle Usage Log
- 401k APG Salary Reduction Agreement
- 403b Salary Deduction Agreement
- APG Change of Status Form
- DPPC Sign Off
- Emergency Procedures and Medical Protocols
- Emergency Procedures Sign-Off Page
- Employee Accident Form
- Employee Incident Warranting Corrective Action
- First Time Home Buyer
- Health Equity DepCare Reimbursement Form – Instructions
- Health Equity FSA-HRA Reimbursement Form – Instructions
- Human Rights Sign-Off
- KEY FORM
- Landis Education Award Policy and Application
- Leave of Absence Request Form 2015
- Medical Leave Assistance Donation Form
- Medical Leave Assistance Program Description
- MHA Change of Status Form
- MHA Internal Application
- MHA Interview Assessment Form – Direct Care
- Orientation Checklist for Program Management
- Orientation Checklist for Program Staff
- Orientation Checklist for Program Staff – YIT
- Physician’s Report- EE Work Status
- Providing & Documenting Rehab
- Reference Check and Internal Applicant Selection Form
- Request for Medical Leave Assistance Form
- Request for Pay in Lieu of Time – PILOT
- Signs & Symptoms 2018 Update
- Updated Change of Status
- Voluntary Resignation Form
- Vehicle Collision Involving MHA Participant Policy
- Wheelchair Transport Observation Sign-Off
- Workplace Risk Reduction Form
- Bloodborne Pathogens Exposure Control Plan
- CBFS HCPOP
- Controlled Substance Disposal Record Form
- Medication Transfer Form – MH Division Only
- Emergency Medical Treatment Refusal Form
- Health Care Provider Orders Progress Note
- MAP Policy Manual
- Medication and Treatment Telephone Facsimile Order Form
- Medication Disposal Form
- Medication Log In Sheet
- DDS Medication Reorder and Tracking Sheet
- DDS Residential Health Care Visit Form 2016
- Medication Occurrence Report 2018
- Medication Occurrence Tracking Sheet
- Medication When on Leave of Absence From Program Form
- Monthly First Aid and Exposure Control Supplies Checklist
- Pass and Pour Checklist Form 2015
- Psychiatrist Sign Off and Review of Annual Physical
- Residential Medication Sheet
- Residential Treatment Sheet
- Seizure Record
- Skin Integrity Chart
- Staff Med Audits Guidelines and Practices
- Utilization of Pre-medication Form