Forms and Documentation

Access all forms, vouchers, and documentation here. If you don’t see a form that you need, please contact us at 603-206-2700.

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:

The Moore Center 
Attention: Health Information Department
195 McGregor Street, Unit 400
Manchester, NH 03102

The Moore Center does not accept electronic signatures. All documents are the latest versions.

State Forms

Visit the New Hampshire Department of Health and Human Services site for state forms.

Agency Forms

Authorization for Behavioral Interventions

Authorization Form for Behavioral/Medical Interventions

Blank Budget

Client Guardian Annual Consent

Client Monthly Financial Record

Client Personal Valuables Record

Consent for Release of Information

Incident Quick Reference Guide

Incident Report CR-066 (NEW FORM)

Incident-Report-Policy-Procedure-Handout-IR-002

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 Agreement

Seizure Report

Wage Status Report – Vendor

Vouchers

Companion Sitter Voucher

Respite Voucher (PDF version can be downloaded here)

Voucher for Items/Services Purchased

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