ER, Hospitalization and Urgent Care Entry Form

Please enter your full name.

For example, Adella House or New Lenox Woodworks

6. Individual's Level of Mobility
8. Gender
9. Type of Report
11. Day of the Week
12. Person Recommending the Visit
13. Was 911 used?
14. Was the physician notified prior to the visit?
15. When was the guardian notified?
16. Is there an Unusual Incident Report associated with this visit?
18. Is this the first visit for this problem?
22. Disposition from ER/Hospital
Please provide the following information in #25:

1. What led up to the event described above?

2. What was the exact issue that caused the event?

3. What was staff's immediate response to the event?

4a. What testing was done?

4b. What was the results of the testing?

5. What treatment was ordered as a result of the testing?

6. Is there any follow-up needed related to this event?

Please give a brief, specific description that includes all requested information (see instruction above).

Program Specialist (Joliet, IL)



Location: Joliet, IL

Program or Service: Residential Networks

Schedule/Shift: Full-time; M-F 3-11 p.m. or 4 p.m.-midnight with two weekends a month

Description: Make a difference! Be a part of clinical team that assists people with developmental disabilities to flourish! The program specialist is involved in providing treatment or assisting with goal attainment for people who have a developmental disability or mental illness in such domains as personal care, recreation/leisure, vocational, home/household, and/or community awareness and integration. The program specialist will develop a strong command over the concepts of positive psychology, complete required readings, and participate in continuing education in their area of specialty as assigned.


  1. Provides behavioral coaching to a person who has a developmental disability or mental illness in assigned treatment areas 
  2. Completes progress reports and other necessary forms or documents 
  3. Participates and interacts with individuals in various activities as specified in Individual Service Plans and Social Transition Plans 
  4. Consults with Behavioral Analyst and Qualified Intellectual Disability Professional concerning appropriate goals, objectives, and treatment techniques 
  5. Assists in the development and execution of goals and objectives for people served 
  6. Makes suggestions for improving Organization and Program effectiveness and efficiency 
  7. Completes a monthly report reflecting Program Specialist intervention 
  8. Completes an annual report, that is assessed quarterly to track progress 
  9. Assists with development and implementation of age-appropriate and functional training materials 
  10. Responsible for working with supervisor in the development of an individual plan of personal growth and development 
  11. Transports persons served to and from appointments and activities as needed 
  12. Complete initial and ongoing medication training; administer medication at multiple locations 
  13. Works with independent living coaches in encouraging their professional growth and knowledge

Minimum Qualifications: Qualified applicants must have their bachelor’s degree in psychology, social work, or a related field.

Contact: Email resume to Laurie Ferfecki at