Resources on Consumer Service Records
The following list of resources is provided to supplement the trainings, publications and other resources on Consumer Service Records contained on this website.
Consumer Service Records
Several centers for independent living (CILs) have made available examples of the forms and documents used in their center.
Access to Independence
- Authorization for Release of Information (pdf)
- Client Assistance Program Information(pdf)
- Personal Information - Need, Use and Disclosure Notice(pdf)
- Written Goal Plan(pdf)
Disability Partners
- Self-Assessment Form(pdf)
Independence First
- Closed CSR Review Checklist (pdf)
An example of a closed CSR review checklist form. - Independent Living Checklist, Creating a Consumer Service Record (CSR) (pdf)
A seven page IL CSR checklist with steps to complete when opening/closing.
Lifetime Independence for Everyone, Inc.
Living Independently for Today and Tomorrow
- Consumer Application Form (pdf)
- Consumer Agreement (pdf)
- Consumer Right and Appeals Process (pdf)
- Authorization for Release of Information (pdf)
- Opening Statement Checklist (pdf)
- Closing Statement Checkslist (pdf)
Tri-County Independent Living Center
Walton Options for Independence
- Grievance Procedure and Client Assistance Program (CAP) (pdf)
- Case Notes Checklist (pdf)
- CSR Control Log (pdf)
- CSR Confidentiality labels template (pdf)
- Consumer Service Records (CSR) folder legalities (pdf)
- CSR Checklist (pdf)
- Independent Living Plan/Waiver and Goals Form (pdf)
- Informationn and Photo Release Form (pdf)
- Service Commitment Form (pdf)
- Voter Registration Declaration Statement (pdf)