Required Forms & Appendices
Every form is fillable in your browser, supports drawn or typed signatures, and can be submitted online or printed.
Resident Forms
Resident Application
Apply for housing at Kura Solution. All information is kept confidential under 42 CFR Part 2 and HIPAA.
Open form →Resident Agreement
Outlines expectations and responsibilities between Kura Solution and the Resident.
Open form →House Rules Acknowledgment
I acknowledge that I have received, read, and understand the Kura Solution House Rules and agree to follow them.
Open form →Consent for Services
Voluntary consent to participate in Kura Solution recovery housing and support services.
Open form →Release of Information (42 CFR Part 2)
Authorization for release of confidential information.
Open form →Emergency Contact & Medical Information
Used in the event of a medical or behavioral emergency.
Open form →Recovery Support Plan
Individualized recovery plan developed with your case manager.
Open form →Medication Disclosure & MAT Acknowledgment
Disclose all prescribed medications and acknowledge medication safety procedures.
Open form →Drug & Alcohol Testing Consent
Consent to random and for-cause drug and alcohol testing.
Open form →Resident Satisfaction Survey
Anonymous and optional. Your feedback helps us improve Kura Solution.
Open form →Operations & Incident Logs
Incident Report
Document any medical, behavioral, or rule-violation incident.
Open form →Grievance / Complaint Form
File a grievance about services, staff conduct, safety, or operations. Retaliation is strictly prohibited.
Open form →Visitor Log
Track every visitor entry to a Kura residence.
Open form →Room Search Log
Document room searches with reason, items found, and notification.
Open form →Naloxone Administration Record
Record any administration of naloxone, EMS contact, and outcome.
Open form →Staff & Compliance
Staff Code of Conduct & Ethics Agreement
Ethical standards, professional boundaries, and confidentiality agreement for Kura staff.
Open form →Staff Training Acknowledgment
Confirmation of completion of required training.
Open form →Billing Compliance Attestation
Certification of accurate and compliant billing practices.
Open form →Case Management Progress Note
Document case management contacts, interventions, and resident progress.
Open form →Peer Recovery Coaching Note
Document peer support contacts and outcomes.
Open form →Life Skills Group Attendance & Progress Log
Track group attendance, topic, facilitator, and engagement.
Open form →Staff Supervision Record
Document supervision sessions, feedback, and follow-up.
Open form →Recovery Works Service Authorization Tracking Log
Track service authorizations, units, and dates for Recovery Works billing.
Open form →Medicaid / Insurance Eligibility Verification
Verify insurance coverage and authorized services for a resident.
Open form →Compliance Audit Checklist
Internal audit of resident files, training, billing, and safety records.
Open form →