Creating Opportunities for People with Disabilities

Agency Forms

Compliance

Reporting of Potential Compliance
Issues

Code of Conduct

Fiscal Services

2009 Employee Expense Instructions	2009 Employee Expense Form - MUST BE SUBMITTED ON GOLD PAPER
Sunoco Gas Card Procedures	Sunoco Gas Card Log
Credit Card Use Policies	Credit Card Usage Form
Mileage Reference List	HEP Mileage Reference List

Training

Internal Training Registration

Training Verification

Heritage-Oak Foundation

Program Donation Form

Heritage Heroes Sign Up

The forms below can either be completed online (fillable) and printed or printed and then hand written. If you complete the form online, print and review the document before you close it. The document will not save on closing.

Admissions

Fillable HEP Routing Slip
Fillable Change of Status	Change of Status

Change of Status Directions

Employee Accidents

Fillable Accident & Injury Report	Accident & Injury Report
Medical Findings & Treatment Report	Authorization to Release Health Information

HealthWorks WNY Locations

Quality Assurance

Fillable OMR 147	OMR 147 and All Attachments
Fillable Accident & Injury Report	Accident & Injury Report
Fillable Notification Page	Notification Page
Fillable CQC Fax Cover	CQC Fax Cover
Fillable DDSO Fax Cover	DDSO Fax Cover
Fillable HIPAA Disclosure - APS	HIPAA Disclosure - APS
Fillable HIPAA Disclosure - CPS	HIPAA Disclosure - CPS
Fillable HIPAA Disclosure - CQC	HIPAA Disclosure - CQC
Fillable HIPAA Disclosure - DDSO	HIPAA Disclosure - DDSO
Fillable HIPAA Disclosure - MHLS	HIPAA Disclosure - MHLS
Fillable HIPAA Disclosure Blank	HIPAA Disclosure Blank
	Body Check Chart

OMR 147 Instructions and Guidelines