Adult foster care licensing resources, forms & training

If you witness or suspect that a resident is being maltreated, abused, or neglected, you must call the state reporting line at 844-880-1574. Also, complete an incident report form.

If a resident is developmentally delayed, mentally ill or elderly, you must report any serious injury or death to the Department of Human Services-Office of the Ombudsman (1-800-657-3591), as well as the case manager, guardian, and your regional licensing specialist.

Access forms and additional information on the OMHDD website >

In compliance with Minnesota statute 9555.6175, the following items require reporting to your regional licensing specialist within the specified timeframes:

• resident death or serious injury, including any that requires medical treatment - immediately with Death/Hospitalization form (PDF)
• Incident report form (PDF)
• diagnosis of a resident, caregiver or household member with a communicable disease - immediately
• fire, storm, or other damage to the home - within 24 hours with Natural Disasters form (PDF)
• building repair or remodeling that requires a building permit - within 24 hours
• change in health status of a caregiver that could affect ability to care for a resident - within 24 hours
• change in the regular membership of the household or caregiver's employment status - within five calendar days
• transfer or voluntary discharge of a resident - within seven calendar days
• involuntary discharge of a resident who does not have an individual service plan - at least 30 days before

You must have written policies and procedures that are reviewed every two years and updated when changes occur. Copies must be provided if requested by your regional licensing specialist.

For your convenience, sample documents or forms have been provided.

• Document Guide (DOC)
• Emergency plan and procedures sample template (DOC)
• Quarterly fire drill log (PDF)
• Vulnerable adult reporting plan with substitute caregiver signatures
• Substitute caregiver plan (PDF)
• Adult foster home program plan (PDF)
• Drug and alcohol policy (PDF)
• Annual GRH agreement
• Background study clearance letters from Net Study 2.0
• Any vulnerable adult investigative material training records
• Fire and escape plan (PDF) - must also be posted
• Adult foster home Program Abuse Prevention Plan - PAPP Sample (PDF)
• Adult foster home Program Abuse Prevention Plan - PAPP (PDF)
• Grievance procedure (PDF) - must also be posted
• EW Termination policy and procedure (DOC)
• Adult Foster Care training records (see "Training" section of this page)
• Medication disposal record (see "Maintenance forms" section of this page)
• AFC without 245D Background Study Roster Reporting (PDF)
• Child Social History Form (PDF) Complete for all new minor household members and when household members turn 13 years old.
• Pet Authorization (PDF)

• Resident information
• Guardianship/conservatorship court papers (updated as needed)
• Cash Resources Record (PDF)
• Medication Documentation (PDF)
• Individual Resident Placement Agreement - IRPA (PDF)
• Medication Disposal Record (PDF)
• Record of medical monitoring equipment training (PDF), required if a resident uses medical equipment 
• Individual Abuse Prevention Plan - IAPP (PDF)
• Adult Foster Care Mobility access assessment (PDF), both original and most recent
• Signed notification of a communicable/contagious disease, if applicable
• Difficulty of care rating sheet, if applicable
• Adult Foster Care Resident Rights (PDF)
• Vulnerable Adult Act Summary (PDF)
• Adult Foster Care Resident Record Enrollment Checklist (PDF)
• Resident progress notes
• Equipment Inspection Form (PDF)

• Prescription Drug Disposal - Region 5 (PDF)
  (Cass, Crow Wing, Morrison, Todd, or Wadena County)
• Prescription Drug Disposal - Region 4 (PDF)
  (Becker, Clay, Douglas, Grant, Otter Tail, Pope, Stevens, Traverse or Wilkin County)
• Fire Extinguisher Reservicing Providers (PDF)
• Well Water Testing Labs (PDF)
• Smoke and Carbon Monoxide Alarms Testing (PDF)