Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
Intermediate Care Facilities for the Mentally Retarded (intellectually disabled) (ICF/MR) 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/.
- Admission Discharge Protocols to Training Centers (2011 Revision)
- Amended Regulations for Respite and Emergency Care Admissions to Mental Retardation Facilities
- Regulations Establishing Procedures for the Voluntary Admission of Individuals Who Are Mentally Retarded to State Mental Retardation Facilities
- Supports for Living Booklet: 3221eID (Word)
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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 Mentally Retarded (ICF/MR).
- Important To-For Worksheet (Word) (pdf)
- Essential Information Long form (Word) (pdf)
- Essential Information - Chart Filing Order (Word) (pdf)
- Part II Profile IV - VA ISP Blank (Word) (pdf)
- Part V Plan for Supports (Word) (pdf)
- Discussion Record Blank (Word) (pdf)
- Communication Plan II (Word) (pdf)
- Personal Schedule Blank (Word) (pdf)
- Revised QMRP Review (Word) (pdf)
- ISP Change Note (Word) (pdf)
- ISP Checklist - data (xls) (pdf)
- The SIS Additional Support Needs Risk Assessment
- Related Forms and Resources:
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- AMC Referral form for Training Centers: 1168eID (Word)
- Emergency and Respite Application (DBHDS #3223eID 2011 Revision)
- AMC Referral form for Training Centers: 1168eID (Word)
- Regular (Judicial Certification) Admission Forms for Training Centers
- Admission Discharge Protocols to Training Centers (DMAS 121 2011 Revision)
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Some of the following links will go to forms that reside on the DMAS Web site.
- Certificate of Patient Status (DMAS 121)
- Certificate of Patient Status-A (Characteristics & Developmental Plan: DMAS 121 A)
- Level of Functioning Survey (Word)
- Social History Form (DMAS 119)
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If you have any questions about the Intermediate Care Facilities for the Mentally Retarded (ICF/MR), please contact:
Susan A. Elmore
Facilities and Community Resource Manager
Office of Developmental Services
Dept. of Behavioral Health and Developmental Services (DBHDS)
P.O. Box 1797
1220 Bank Street
Richmond, Va. 23218-1797Email: Susan.Elmore@dbhds.virginia.gov
Office Phone: 804-371-2478
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- Contact
- Forms:
- Regulations
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| ID Regular Application Package
(Training Center Application Package and Instructions): Application Instructions (for the following forms) |
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| 1146CeMR 1146BeMR 1146AeMR 1146DeMR 1166eMR 1167eMR 1168eMR 1147eMR [ top of page ] |
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