Provided Forms

The Oregon ISP process includes standardized forms which are to be used whenever Medicaid-funded I/DD services are delivered.

Person Centered Information

2017 Versions

Reader PDF: SDS 4115    Pro PDF: SDS 4115P
Learn more about the PDF versions.

Alternate Microsoft Word versions
Adults: SDS 4115A        Youth: SDS 4115Y

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Translated versions available.

Person Centered Information is the foundation of the planning process. The purpose of the form is to carefully and respectfully record the person’s perspective about a wide range of areas in his/her life. There is space for additional information to be added, when needed, and space at the end to note who contributed to this document.

Beginning in 2017, the document is provided in Adult and Youth versions.

The complete Person Centered Information form(s) is filed with the ISP at the CDDP or Brokerage.

Family members, as directed by the person, are encouraged to contribute information to this form. Providers that serve a person who lives in a Residential setting have a responsibility to update information on this form and share it with the SC/PA prior to the ISP meeting. See Person Centered Information in the ISP Manual.

Risk Identification Tool

2017 Versions

Reader PDF: SDS 4116    Pro PDF: SDS 4116P
Learn more about the PDF versions.

2015 Versions - still valid for use

Standard: 2-Risk_Identification_Tool_6-18-2015
Large print: 2-Large_Print_Risk_Identification_Tool_6-18-2015

This form is currently only available in English.

This tool is used to identify known, serious risks in the person’s life. Risks which are marked with a “Yes” response are recorded on the ISP Risk Management Plan along with the strategy to address the risk. This document is best completed or reviewed near the time of the Needs Assessment as similar information is covered.

The complete Risk Identification Tool is filed with the ISP at the CDDP or Brokerage.

Providers that serve a person who lives in a Residential setting have a responsibility to communicate any known changes in serious risks with the SC/PA in a timely manner.

Individual Support Plan

2017 Versions

This version is required beginning in September 2017 for plans that are due in November 2017 and for ISP planning with people new to services.

The current version of the ISP form is dated 11/2017.

Reader PDF: SDS 4118  Pro PDF: SDS 4118P
Learn more about the PDF versions.

Translated versions available.

The ISP begins with at least one One Page Profile, a positive introduction to the person, which can be customized to reflect the person’s personality and preferences.

The ISP reflects the person’s desired outcomes, career development plan, risk management plan, and chosen services. It has space to record any differences of opinion as well as any legal relationships present in the person’s life.

The complete ISP is filed at the CDDP or Brokerage. A copy of the ISP is provided to the person, his guardian or designated representative and any others directed by the person. Providers must receive a copy of the plan or a detailed service agreement or job description.

Change Form

2017 Versions

Reader PDF: SDS 4119 Pro PDF: SDS 4119P

Learn more about the PDF versions.

2015 Versions - still valid for use

Standard: 5-Change_Form_1-20-2015

This form is also available in the following languages: Arabic, Somali, Russian, Spanish, Vietnamese.

A change form is used to document any agreed changes to the ISP or related materials. It may be initiated by the person, guardian, family, provider, or SC/PA. To streamline the change process, some changes may be made immediately by notifying ISP team members. Other changes, such as adding or discontinuing services, require approval. The change form provides documentation of what was changed, when it was changed, and who was notified or gave approval for the change.

Completed change forms are filed with the ISP at the CDDP or Brokerage. Providers must be notified of changes which impact the services they are expected to deliver, by providing a copy of the change form, changed document, or updated job description or service agreement.

For complete instructions, see the chapter called Making Changes in the ISP Instruction Manual.

Tools for implementing the ISP

Action Plans

Action Plans

  • Basic example Action Plan format (Word, locked) (Word, unlocked) (PDF)
  • More detailed example Action Plan format (PDF)
  • Personal Action Plan This is an example of a simple action plan that could be used by anyone. It provides a framework for thinking through and recording specific steps they can take toward accomplishing a desired outcome. (Word)

Provider organizations are expected to develop implementation strategies, such as Action Plans, to train their staff how to support the person toward his/her Desired Outcomes. Provider organizations and foster providers are also free to create their own action plan templates.

See the chapter called Implementing the ISP in the ISP Instruction Manual.

Provider Risk Management Strategies

Provider Risk Management Strategies

  • Provider Risk Management Strategies form (Word)

This form is prepared by provider organizations and foster providers who maintain written instructions such as protocols, safety plans, and other support documents for their staff or substitute caregivers to follow. This form is typically not used with PSWs or Independent Contractors, unless specifically directed by the SC/PA.

The ISP Risk Management Plan or the provider’s service agreement details the specific risks which are to be addressed in that setting. The provider organization or foster provider completes this form listing each identified risk and the document(s) that are in place to address it. The form includes space to list the title, date, and location where each document is kept.

Providers share an updated copy of this form with the SC/PA prior to the ISP meeting and anytime it is updated.

Support Documents (Protocols and Financial Plan)

For more information about this topic, please visit our Support Documents page.

Other available forms

These additional materials are provided to support development and implementation of the ISP.

Who do you want involved in planning your life?

Who do you want involved in planning your life?

  • Who do you want involved in planning your life? (Word)

This tool provides an example framework for structuring a conversation with the person about who is involved in planning.

Supporting Questions - to gather more meaningful information

Supporting Questions for Person Centered Information

These questions are provided as an additional, optional tool to assist you in gathering more meaningful Person Centered Information.

ISP Meeting Agenda

2017 Versions (available by 5/1/2017)

Reader PDF: SDS 4117 Pro PDF: SDS 4117P

Learn more about the PDF versions.

2015 Version - currently valid for use

Download form: 3-Agenda_1-20-2015

Other available languages: Arabic, Somali, Russian, Spanish, Vietnamese.

This document serves as a record of the key topics discussed at the ISP meeting and the outcome of the discussion. It includes a number of topics to consider for discussion.

The complete ISP Meeting Agenda, if used, is filed with the ISP at the CDDP or Brokerage.

The person receiving services, his/her invited friends and family members, and providers may contribute discussion topics to the ISP meeting agenda.

Note that as of June 2016, a Discussion Record is also available. See elsewhere on this page.

Discussion Record

Discussion Record

  • Discussion Record (Word)
  • Discussion Record instructions (Word)

A Discussion Record is an optional tool that ISP teams can use to record issues they have discussed and the outcome of their discussion. When referenced within the ISP or when accompanied by an ISP Change Form, the Discussion Record serves as a part of the person’s ISP.

Required Software

For published forms in PDF format, please visit our Adobe software page to learn more about the required software. Need help downloading and opening the forms? If you're seeing a "Please Wait..." error message, try reading this article. Still need help? Contact us!

Other forms are provided in Microsoft Word version. They are intended for use with Microsoft Word 2007 and later, though they may also be used with earlier versions of Word with more limited functionality.