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Intermediate Care Facilities for the Intellectually Disabled (ICF/ID)

Intermediate Care Facilities for the Intellectually Disabled (ICF/ID) for children and adults are licensed by the DBHDS Office of Licensing, then a provider must be certified by the Virginia Department of Health, Office of Licensing and Certification, whose contact information may be found at the following link: http://www.vdh.virginia.gov/OLC/longtermcare/

Regulations Affecting State Training Centers

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ICF/ID Forms for PCP

Following is a list of Virginia Person Centered Planning (PCP) Process forms for use by providers of care for persons who reside in Intermediate Care Facilities for the Intellectually Disabled (ICF/ID).

  1. Important To-For Worksheet  (Word) (pdf)
  2. Essential Information Long form  (Word) (pdf)
  3. Essential Information - Chart Filing Order  (Word) (pdf)
  4. Part II Profile IV - VA ISP Blank  (Word) (pdf)
  5. Part V Plan for Supports  (Word) (pdf)
  6. Discussion Record Blank  (Word) (pdf)
  7. Communication Plan II  (Word) (pdf)
  8. Personal Schedule Blank  (Word) (pdf)
  9. Revised QMRP Review  (Word) (pdf)
  10. ISP Change Note  (Word) (pdf)
  11. ISP Checklist - data  (xls) (pdf)

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Emergency and Respite Applications to Training Centers

Regular (Judicial Certification) Admission Forms for Training Centers

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ICF/ID Private and CSB forms for Admission

Some of the following links will go to forms that reside on the DMAS Web site.
DMAS forms 119, 121 and 121 A, please email Susan directly for instructions (email listed below)

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Contact Information

If you have any questions about the Intermediate Care Facilities for the Intellectually Disabled (ICF/ID), please contact:

Susan A. Elmore
Quality Management and Development
Dept. of Behavioral Health and Developmental Services (DBHDS)
P.O. Box 1797
1220 Bank Street
Richmond, Va. 23218-1797

Email: Susan.Elmore@dbhds.virginia.gov

Office Phone: 804-371-2478

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Regular (Judicial Certification) Admission Forms for Training Centers

ID Regular Application Package (Training Center Application Package and Instructions):

     Application Instructions (for the following forms)

1146CeMR
1146BeMR
1146AeMR
1146DeMR
1166eMR
1167eMR
1168eMR
1147eMR

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