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Provider Service Logs (Sample Forms) 660-05-65-95

(Revised 5/1/19 ML 3549)

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As a part of the Adult Foster Care licensing process, applicants are required to provide examples of service logs that will be used to account for service time and tasks performed.

 

A provider may create their own service log provided it meets the standards for accounting of services provided.

 

An example service log must be completed by the applicant and kept in the provider’s file. A copy must be sent to the Aging Services Division for their records.

 

For AFC providers caring for individuals on public pay programs, specific information will be required on the provider service log. Providers will receive provider service logs from Medical Services/Home and Community Based Services.

 

These forms may be duplicated.

 

 

 

 

 

 

 

 

 

 

 

 

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