Assisted Living Home Resources

CALL AZDHS (602) 542-1025 ASK FOR RESIDENTIAL LICENSING, SURVEYOR OF THE DAY FOR ALL YOUR ALH QUESTIONS

Contact Monica Stamos with Assisted Living Licenses, Certficates & Training for assistance (not affiliated with INtouch Senior Services) *Recommended
602.384.1146 | Training@ALLCT.com | https://allct.com

Contact Jeff Calvert with Assisted Living Compliance Services for assistance (not affiliated with INtouch Senior Services) *Recommended
602.361.6369 | jeffalcspro@gmail.com | https://assistedlivingcomplianceservices.com

Contact Gabriela Istrate with for assistance (not affiliated with INtouch Senior Services) *Recommended
602.439.7307 | gabrielagoldenage@cox.net |


FORMS

Please review the forms used with the Arizona Department of Health Services Regulations before implementing them in your Facility. Keep in mind these forms are examples of what you can use, some forms may be out of date.


2018 Minimum Wage Poster (English)

AZ Earned Paid Sick Time Poster 2017

AZDHS Rules & Regulations Article 1 & 8 (print and have available for staff)

Inspection Records Notice (conspicuously posted)

a) DURABLE HEALTH CARE POWER OF ATTORNEY

b) DURABLE MENTAL HEALTH CARE POWER OF ATTORNEY

d) LIVING WILL (End of Life Care)

e) PREHOSPITAL MEDICAL CARE DIRECTIVE (DO NOT RESUSCITATE)

 9. Completed W-9 (Request for Taxpayer Identification Number and Certification), A4 (Employee’s Arizona Withholding Election)

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