ACCENT on Family Care Services, LLC
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FAX: 480-677-3477

 
E-mail:
debbielee@accentonfamily.com

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FOLLOWING ARE FORMS THAT CAN BE PRINTED

 

 

Electronic Time Sheet Instructions

Manual Time Sheet download

All days worked between the 1st and the 15th of the month must be mailed to ACCENT by the 16th.  All days worked between the 16th and 31st must be on another time sheet and be mailed to ACCENT no later than the first day of the following month.  Time sheets can be delivered, faxed or emailed, however, the original must be mailed as well. If time sheets are not received on a timely basis then paychecks may not be issued until the following pay period. Both the parent and provider must sign the bottom of the time sheet and the parent must initial after every day that is worked.  Round each day's total to the nearest quarter hour.  Time sheets must be submitted free from errors and corrections.  Please note that respite must be less than 12 hours per calendar day.  The State will not pay for more than 11.75 hours. 

Paychecks will normally be received within 10 days of the end of the time period which is either the 10th or the 25th of each month.  If the 10th or 25th fall on a weekend or holiday then your pay may be received the following business day.

Employee's must input their hours on the electronic time card on ddreports.  Inputting hours on ddreports will help ensure that the hours can be paid.  Please look at the above link for instructions on how to input the hours electronically. 

Before working with a family, providers must have the guardian fill out the "Family Information Forms" as well as the Pre-service Provider Orientation.  These forms must be signed by both the parent and the provider. ACCENT must have a copy of all of these forms on file before the provider is eligible to start working with the family.  

FAMILY FORMS

Pre-Service Provider Orientation

Agreement to Not Transport Client

If the provider will not be able to drive then they must fill out and return the agreement to not transport.

Transportation Waiver download

The transportation waiver must be signed by both the parent/guardian and provider
before the provider may transport child/client.

TRANSPORTATION POLICY

GRIEVENCE, EVALUATIONS, EXPECTATIONS, COMMENTS FORMS

INCIDENT REPORT download

Click here for complete information regarding INCIDENT REPORTING


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Provider's must keep data on the client's habilitation goals that are worked on every month.  By the first day of the following month, this habilitation sheet must be completed and sent to the support coordinator and mailed with the end of the month time sheet to ACCENT. 

Where to send Habilitation and Attendant Care Reports:

 

If you work with families in the West Valley Area:

Email them to: DDDWestProgressReports@azdes.gov

Or mail hard copy attn: Marianna Mendoza

Surprise Office,11526 West Bell Road Surprise, AZ 85378

 

If you work with families in the East Valley Area:

Email them to: DDDEastProgressReports@azdes.gov

Or mail hard copy attn: Alice Amarillas

120 W 1st Ave.,Mesa AZ 85210

 

If you work with families in the Central Phoenix Area:

Email them to: DDDCentralProgressReports@azdes.gov

Or mail hard copy attn: Angie Otero

4000 North Central #900, Phoenix, AZ 85012

 

If you work with families in the Northern Arizona:

Email them to: DDDD3ProviderReports@azdes.gov

 

If you work with families in the Southern Tucson Area:

Mail reports to: DDD, PO Box 13178, Tucson, AZ 85732-3178 

Click here for HABILITATION data form

Habilitation Documentation

Click here for habilitation data sample

ATTENDANT CARE Data Form

Potty Training Data Sheet download

Physicians Standing Order download file

When providers administer non-prescription drugs, this form must be filled out and signed by the physician and client's parents.

Medicine Log download

 Anytime a provider administers over-the-counter medicine or
prescription medicine the date and dosage must be filled
out on
this form.  This form must be returned to ACCENT
at the end of
every month.