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Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Intermediate Care Facilities for Individuals with Intellectual Disabilities –(ICF/IID)– 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/.

Individuals Seeking Community Placement please click here.

Regulations Affecting State Training Centers

ICF/IID 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 Individuals with Intellectual Disabilities (ICF/IID).

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

Emergency and Respite Applications to Training Centers

The SIS® Additional Support Needs Risk Assessment

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

Level of Functioning Survey