Forms
Collected clinical documents and forms for the Comprehensive Program.
Forms Heading link
The following available Comprehensive Program forms must be encrypted using Entrust and submitted according to the process listed in the “Document Submission Process” document. All other documents can be found and submitted in the WebApp data system.
Note that links below will open the documents in a Google Drive viewer; they must be downloaded and completed using Microsoft Word before being submitted.
- Process Overview
- Outreach and Assessment Forms
- 1.1 Informed Consent (4/5/2022)
- 1.2 Outreach Activity Outcome (9/22/23)
- 1.2a Outreach Referral for Assessment (9/22/23)
- 1.2bOutreach Refuse or Decline Outcome Letter(9/22/2023)
- 2.2 Rights and Appeal Process (9/13/23)
- 2.3 Facility Record Request (9/13/23)
- 2.5 Transition Proceeding Notification (9/13/2023)
- 3.3 24 Hour Back-Up Plan (9/22/2023)
- 3.4 Transition Checklist (2/10/2020)
- 3.7 Discharge Meeting Guide (9/22/2023)
- Housing Forms
- 4.2 Bridge Subsidy Overview
- 4.2 Bridge Subsidy Packet
- 4.3 Bridge Subsidy Administrator Referral
- 4.4 Bridge Subsidy Participation Agreement
- 4.5 Referral for Transition Coordination
- 4.6 Bridge Subsidy Information for Landlords
- 4.6a Bridge Subsidy Information for Landlords (no income) (9/20/2021)
- 4.7 Bridge Subsidy Inspection Request
- 4.8 Bridge Subsidy Tenant Tips
- 4.8a Bridge Subsidy Participant Handbook
- 4.9 Bridge Subsidy Opt-Out
- 4.10 Bridge Subsidy Waiver Request
- 4.11 Certification of Zero Income
- 4.12 Bridge Subsidy Employment Incentive Program
- 4.14 Bridge Subsidy Additional Bdrm Housing Agreement
- 4.15 Bridge Subsidy Instructions for Property Managers
- 4.16 Bridge Subsidy Deeper Dive
- 4.17 Bridge Subsidy Flyer
- 4.18 Bridge Subsidy Housing Retention Financial Assistance Request
- 4.19a Bridge Subsidy Reinstatement Request
- 4.20 Williams Colbert Initiative Referral Form
- Transition Forms
- 2.6 CAST Review Checklist 12/4/23
- 5.3 Secondary Transition Recommendation & Plan
- 5.4 Post-Transition Decline Letter 9/22/23
- 5.5 Post-Transition CCMTP Closure Letter 9/25/23
- 5.6 Discharge Resources 9/25/23
- 6.3 SOAR Service Deliverables and Reporting
- Quality of Life Overview Handout (11/27/2023)
- Special Processes
- 6.4 Neuropsychological Evaluation Referral
- 6.5 IDHS Consent Form (2/28/2020)
- 6.6 Neuropsychological Evaluation Flyer (9/22/2023)
- 6.8 UIC-ATU Contacts by Phase (6/23/2023)
- 6.9 UIC ATU Intake (5/18/2023)
- 6.10 UIC ATU Request for Phase 2 Services (8/23/2023)
- 6.11 UIC ATU Request for Phase 3 Services (5/19/2023)
- 6.15 Acceptable Identification Documents (9/2022)
- 6.16 Residual Capacity Examination Report
- IDPH Complaint Form (2/2/2022)