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Intensive In-home Services
Program Forms
Do NOT attempt to fill in these forms online.
Click on the document names below, and "Save As" to the selected folder on your local hard drive.
Then enter your data on the form on your local computer
(Read Password Protection note below.)
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Intensive In-home Services Brochure
Intensive In-home Services forms
CD Cover Sheet for Client File (IIS) form, revised 2013-07-01
Client Records Checklist (IIS) form, revised 2013-07-01
Client Records Face Sheet (IIS) form, revised 2019-06-01
Client Records Policy Statement (IIS) form, revised 2013-07-01
Completion Letter To Family (IIS) form, revised 2013-07-01
Consent For Counseling (IIS) form, revised 2013-07-01
Consent For Transportation (IIS) form, revised 2013-07-01
Consent, Exchange Information (IIS) form, revised 2013-07-01
Critical Client Incident Report [FCF] form, revised 2013-07-01
Early Termination Notice (IIS) form, revised 2013-07-01
Family (Satisfaction) Survey (IIS) form, revised 2013-07-01
Family Support Team Meeting Report (IIS) [FCF] form, revised 2013-07-01
Flowchart for FACES IIS Referrals (2023) form, revised 2023-12-27
Follow Up Services Plan (IIS) [FCF] form, revised 2013-07-01
HIPAA & CAN Disclosure Cover Sheet form, revised 2013-07-01
HIPAA PHI Disclosure Tracking Log form, revised 2013-07-01
HIPAA Privacy Notice form, revised 2013-0, revised 2013-07-017-01
IIS-IFRS Peer Record Review Protocol form, revised 2013-02-01
IIS-IFRS Peer Record Review Protocol Tool Instr, revised 2013-02-01
Initial Family Assessment (IIS) [FCF] form, revised 2013-07-01
Initial Screening Letter (IIS) form, revised 2014-11-01
Initial Screening Narrative (IIS) [FCF] form, revised 2013-07-01
Intervention Fund Expenditures Log (IIS) form, revised 2013-07-01
Intervention Fund Request & Approval (IIS) form, revised 2013-07-01
Level of Risk Assessment form, revised 2019-06-01
Participation Agreement (IIS) form, revised 2014-11-01
Safety Plan [FCF] form, revised 2015-11-01
Service Plan & Family Goal Sheet (IIS) [FCF] form, revised 2014-11-01
Termination (Closing) Summary (IIS) [FCF] form, revised 2013-07-01
Transmittal Letter, Termination Summary (IIS) form, revised 2013-07-01
Weekly Narrative Summary (IIS) [FCF] form, revised 2013-07-01
Weekly Supervision Log (IIS) [FCF] form, revised 2013-07-01
Password Protection
Because programs forms usually contain HIPAA protected personal information of clients, the Family Facets forms are password protected, and must have a password to open and view the form. Any Agency representative interested in viewing or using the Family Facets forms should send an email to FamilyFacets@FamilyFacets.com in order to obtain a complimentary password to open and view a form.
Only a portion of the Family Facets forms for each program has been included in the downloadable forms on the accompanying pages. For a complimentary CD-ROM of the complete set of Family Facets forms for a particular program, please send your Agency's email request to FamilyFacets@FamilyFacets.com.
Intensive In-home Services (IIS-IFRS) program page.
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