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Instructions: right-click the document you want and save it to your computer. These are Word, Excel and PDF documents some of which contain fields that can be filled in, but not altered. You can fax the completed form to 603-206-9015 or mail them to:
Moore Center Services
Attention: Health Information Department
195 McGregor Street, Unit 400
Manchester, NH 03102
Moore Center Services does not accept electronic signatures. All documents are the latest versions.
Visit the New Hampshire Department of Health and Human Services site for state forms.
Authorization for Behavioral Interventions
Authorization Form for Behavioral/Medical Interventions
Authorization for E-Communication
Client Guardian Annual Consent
Client Monthly Financial Record
Client Personal Valuables Record
Consent for Release of Information
Documentation Deadlines form (PDF)
Incident Report Case Notes (electronic)
Incident Report Case Notes (printed)
Incident Report
Level of Services – Consolidated Services
Level of Services – Day Services
Level of Services – Residential Services
Level of Services – (In-home Supports)
Request for Client Information
Request for Shared Certification Letter
Residential Case Management Agreemen
Seizure Report
Wage Status Report – Vendor
Companion Sitter Voucher
Respite Voucher (PDF version can be downloaded here)
Voucher for Items/Services Purchased
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