Policy Procedure Manual
Professional Policy Procedure Manual template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Policy Procedure Manual
TEMPLATE • Inspection-Ready AFH Standard
1. Abuse & Mandated Reporting Policy
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. Emergency Medical Services & 911 Policy
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Disaster Preparedness & Facility Evacuation
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (8 Sections)
Abuse & Mandated Reporting Policy
Zero tolerance protocols, DSHS/CPS/APS mandatory reporting timelines, and immunity disclosures.
Emergency Medical Services & 911 Policy
CPR authorization, 911 dispatch protocols, paramedic access, and emergency contact notifications.
Disaster Preparedness & Facility Evacuation
Fire evacuation routes, emergency shelter locations, backup power, and 72-hour food supply.
Medication Management & Storage Policy
Lockbox security, MAR documentation rules, PRN authorization, and RN delegation guidelines.
Accident Prevention & Workplace Safety Plan
Fall prevention standards, wet floor hazards, chemical storage (SDS), and caregiver lifting limits.
Documentation & Resident Recordkeeping Rules
Daily logbook entries, incident documentation, HIPAA privacy rules, and record retention.
Infection Control & Outbreak Response Policy
Sanitization schedules, PPE standards, resident isolation protocols, and illness screening.
Staff Acknowledgment & Annual Review Log
Employee policy review sign-off, annual policy updates, and provider compliance verification.
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