You may download these forms and use them when you do not have immediate access to an Internet connection. Simply take a printout and copy the relevant information onto one of these forms. You can transfer the information into the system later or hand the completed form over to other authorized users of Therap who can get the information into the system for you.


 

Therap Applications Offline Forms


T-Logs/Individual Data Forms

(Download these as a single .zip file)

T-Log Individual Data Form

ISP Data

ISP Data

Individual Support Plan

Individual Support Plan

General Event Reports

(Download these as a single .zip file)

General Event Reports

Injury : Form-GER(a)

Witness Report (Restraint Related to Behavior)

Medication Error : Form-GER(b)

Restraint Related to Behavior : Form-GER(c)

Restraint Other : Form-GER(d)

Death : Form-GER(e)

Other : Form-GER(f)

Witness Report

Health Tracking

(Download these as a single .zip file)

Intake/Elimination Input Form

Lab Test

Seizure

Immunization Record

Appointments

Consultation Form

Medication History

Skin/Wound Assessment

Blood Glucose

Menses

Vital Sign

Infection Tracking

Respiratory Treatment

Height/Weight

Individualized Plan of Protective Oversight and Safeguards

(Download these as a single .zip file)

General Information

Work Center Safeguard

Residential Information

Individualized Services Safeguard

Day Program Safeguard

Information for Transportation

Supported Employment Safeguard

Medication Administration Records

MAR Offline Form

Personal Focus Worksheet

Personal Focus Worksheet

State Specific Offline Forms

Arizona

Arizona State Specific Information

California

California Initial Form

California Follow-up Form

Colorado

Colorado Incident Report

Connecticut

Connecticut State Specific Information- Injury (Connecticut DDS-IR-255)

Connecticut State Specific Information- Injury (Connecticut DDS-IR-255 OH/FAM)

Connecticut State Specific Information- Medication Error (Connecticut DDS-MER-255m)

Connecticut State Specific Information- Other (Connecticut DDS-IR-255)

Connecticut State Specific Information- Other (Connecticut DDS-IR-255 OH/FAM)

Connecticut State Specific Information- Restraint Other (Connecticut DDS-IR-255)

Connecticut State Specific Information- Restraint Other (Connecticut DDS-IR-255 OH/FAM)

Connecticut State Specific Information- Restraint Related to Behavior (Connecticut DDS-IR-255)

Connecticut State Specific Information- Restraint Related to Behavior (Connecticut DDS-IR-255 OH/FAM)

Delaware – Individual Data Form & General Event Reports for Delaware Users

IDF for Delaware Users

GER – Restraint Other for Delaware Users

GER – Injury for Delaware Users

GER – Death for Delaware Users

GER – Medication Error for Delaware Users

GER – Other for Delaware Users

GER – Restraint Related to Behavior for Delaware Users

Delaware – State Specific Information – GER

Florida

Florida State Specific Information – Incident Report

Florida State Specific Information – Medication Error Report

Florida State Specific Information – Follow-up-Report

Maine

Maine State Specific Information

Maryland

Maryland State Specific Information

New Jersey

New Jersey State Specific Information – Incident Report

New Jersey State Specific Information – Follow-up Report

New Mexico

Comprehensive Health Assessment Tool (eCHAT)

Guidance for Comprehensive Health Assessment Tool (eCHAT)

Medication Administration Assessment Tool (MAAT)

Aspiration Risk

New York

New York State Specific Form – OPWDD 147

New York State Specific Form – OPWDD 148

New York State Specific Form – OPWDD 150

Oklahoma

Oklahoma State Specific Information

Washington

Washington State Specific Information

GER en Español


REG: Formulario de Muerte

Reporte de Eventos Generales (REG)

REG Tipo de Evento ­Lesión

REG Tipo de Evento­ Otro

REG: Formulario-Otras Restricciones

Reporte de Eventos Generales-Reporte de Testigos