Forms

Below are a list of common forms, checklists, and assessments that can be used in the Technology Implementation process to find, evaluate, and secure funding for devices and services.

Measurement Guide and Checklist Example

A form that can be used as a starting point for assessment and evaluation of technology supports.

Transition Checklist

A checklist developed by CCRI to track completion of items when transitioning person served to their Independent By Design program, which leverages technology supports.

Care Profile

A form developed by Sengistix to track important contacts, technology information, and actions plans. Blank form and example provided.

Apartment Ready Checklist

This checklist is to be used when a client/team feels an apartment setting would be an option for a client.

Assistive Technology Assessment and Flow Chart

The DHS Olmstead Plan outlines several key goals that must be accomplished to ensure people with disabilities are living, learning, working, and enjoying life in the most integrated setting possible.

How do the numbers add up?

Do the Numbers

When deciding to implement a new support strategy it is important to run a cost analysis to fully plan out the business case for your organization. A sample cost analysis has been created below that can be used to help analyze anticipated costs and revenue when going from on-site sleep to alternative overnight supervision.

Remote monitoring assessment

Remote Monitoring Technology Assessment

This assessment was created by the State of Ohio to specifically assist in the process of including remote monitoring technology as part of an individual’s care plan.

Person Centered Technology Assessment

Person Centered Technology Assessment

This document was created to support initial conversations related to using technology supports for people served by Hammer Residences, Inc. Hammer staff utilize this document after an initial general consultation and is intended to describe the individual’s functional skills and abilities concerning the need for technology as a support as well as outline possible solutions and future outcome documentation.