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Texas Department of Aging and Disability Services. Form 4122. April 2014-E. Home and Community-based Services. Host/Companion Service Delivery Log.

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How to fill out the Host/Companion Service Delivery Log online

The Host/Companion Service Delivery Log is an essential document used in home and community-based services to record the daily activities and support provided to individuals. This guide will help you navigate through the online process of completing this log efficiently and accurately.

Follow the steps to fill out the Host/Companion Service Delivery Log

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the individual’s name in the appropriate field, including both first and last names.
  3. Fill in the location where the services are being provided. This should be the specific address or setting.
  4. Input the local case number or case ID for reference to the individual's case.
  5. Specify the week of service by entering the corresponding start date.
  6. At the end of each day, review the activities completed with the individual and mark (initial or check) each item that was performed. Ensure that all days from Sunday to Saturday are accurately logged.
  7. If there were any incidents, concerns, or special events during the week, document these in the comments section located at the bottom of the form.
  8. In the 'Activities of Daily Living' section, indicate which activities were assisted and whether they were completed.
  9. In the 'Habilitation' section, identify the skills or activities the individual participated in to enhance their capabilities.
  10. In the 'Assisting With' section, tick all relevant tasks that you provided assistance for during the week.
  11. If applicable, indicate any non-home activities, such as temporary discharge or leave status.
  12. Complete the host/companion initials and print name fields to confirm your involvement in the service delivery.
  13. Sign in the designated area as the host/companion staff, and enter your staff ID.
  14. Review all entries for accuracy, then proceed to save changes, download, print, or share the completed form as necessary.

Start completing your Host/Companion Service Delivery Log online to ensure proper documentation of services.

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