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Professional Policy Procedure Manual template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
TEMPLATE • Inspection-Ready AFH Standard
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
Base 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.
Provider Signature / Date
Resident / POA Signature / Date
Get immediate access to the complete, unblurred Microsoft Word (.docx) and PDF files.
Zero tolerance protocols, DSHS/CPS/APS mandatory reporting timelines, and immunity disclosures.
CPR authorization, 911 dispatch protocols, paramedic access, and emergency contact notifications.
Fire evacuation routes, emergency shelter locations, backup power, and 72-hour food supply.
Lockbox security, MAR documentation rules, PRN authorization, and RN delegation guidelines.
Fall prevention standards, wet floor hazards, chemical storage (SDS), and caregiver lifting limits.
Daily logbook entries, incident documentation, HIPAA privacy rules, and record retention.
Sanitization schedules, PPE standards, resident isolation protocols, and illness screening.
Employee policy review sign-off, annual policy updates, and provider compliance verification.
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