{"product_id":"continuous-unauthorized-leave-form-15892","title":"Elopement Risk Assessment \u0026 Unauthorized Leave Tracking Form – Home Care, Assisted Living and Group Home Template","description":"\u003cp\u003eTrack recurring unauthorized leave, wandering, and elopement incidents with this professional Continuous Unauthorized Leave \u0026amp; Elopement Risk Assessment Template.\u003cbr\u003e\nDesigned for home care agencies, assisted living facilities, memory care programs, group homes, behavioral health programs, and residential care providers, this customizable form provides an organized way to document repeated incidents, identify patterns, assess contributing factors, record previous interventions, and develop an ongoing safety plan.\u003c\/p\u003e\n\u003cp\u003eThe template includes 30-, 60-, and 90-day tracking, making it especially useful when a single incident report is not enough to document an ongoing pattern of unauthorized leave or wandering behavior.\u003c\/p\u003e\n\u003cp\u003eWHAT’S INCLUDED\u003cbr\u003e\nThis Continuous Unauthorized Leave Form includes sections for:\u003cbr\u003e\n• Client \/ Resident Information\u003cbr\u003e\n• Elopement \u0026amp; Unauthorized Leave Risk Factors\u003cbr\u003e\n• 30-Day Incident Tracking\u003cbr\u003e\n• 60-Day Incident Tracking\u003cbr\u003e\n• 90-Day Incident Tracking\u003cbr\u003e\n• Incident History \u0026amp; Documentation\u003cbr\u003e\n• Most Recent Incident Summary\u003cbr\u003e\n• Contributing Factors\u003cbr\u003e\n• Client Condition Assessment\u003cbr\u003e\n• Risk Level Assessment\u003cbr\u003e\n• Family \/ Responsible Party Notifications\u003cbr\u003e\n• Previous Interventions Attempted\u003cbr\u003e\n• Current Corrective Action Plan\u003cbr\u003e\n• Safety Planning\u003cbr\u003e\n• Supervision Considerations\u003cbr\u003e\n• Administrative Review\u003cbr\u003e\n• Continued Monitoring\u003cbr\u003e\n• Discharge \/ Transition Considerations\u003cbr\u003e\n• Signature \u0026amp; Acknowledgment Section\u003c\/p\u003e\n\u003cp\u003ePERFECT FOR\u003cbr\u003e\n• Home Care Agencies\u003cbr\u003e\n• Assisted Living Facilities\u003cbr\u003e\n• Memory Care Programs\u003cbr\u003e\n• Group Homes\u003cbr\u003e\n• Residential Care Programs\u003cbr\u003e\n• Supportive Living Programs\u003cbr\u003e\n• Behavioral Health Programs\u003cbr\u003e\n• Adult Residential Facilities\u003cbr\u003e\n• Senior Care Providers\u003cbr\u003e\n• Hospice \u0026amp; Healthcare Providers\u003cbr\u003e\n• Program Administrators\u003cbr\u003e\n• Care Coordinators\u003cbr\u003e\nTRACK RECURRING ELOPEMENT \u0026amp; UNAUTHORIZED LEAVE\u003cbr\u003e\nWhen unauthorized leave occurs repeatedly, documenting each event individually may not provide a complete picture of the pattern.\u003cbr\u003e\nThis form provides a centralized place to:\u003c\/p\u003e\n\u003cp\u003e✓ Track incidents over 30, 60, and 90 days\u003cbr\u003e\n✓ Identify recurring patterns\u003cbr\u003e\n✓ Document the most recent incident\u003cbr\u003e\n✓ Record contributing factors\u003cbr\u003e\n✓ Assess changing risk levels\u003cbr\u003e\n✓ Document family or responsible-party notifications\u003cbr\u003e\n✓ Record interventions already attempted\u003cbr\u003e\n✓ Establish corrective actions\u003cbr\u003e\n✓ Develop an updated safety plan\u003cbr\u003e\n✓ Document administrative decisions\u003cbr\u003e\n✓ Maintain organized resident records\u003c\/p\u003e\n\u003cp\u003eELOPEMENT RISK ASSESSMENT\u003cbr\u003e\nUse the risk assessment section to document factors that may contribute to recurring wandering or unauthorized leave.\u003cbr\u003e\nThe form can help your organization maintain a written record of the resident or client's current circumstances, incident history, identified concerns, and interventions.\u003c\/p\u003e\n\u003cp\u003eThis may be especially useful when supporting individuals who require additional supervision due to cognitive, behavioral, or other care needs.\u003c\/p\u003e\n\u003cp\u003e30 \/ 60 \/ 90-DAY INCIDENT TRACKING\u003cbr\u003e\nUnlike a standard incident report, this template includes dedicated 30-, 60-, and 90-day tracking to help identify recurring patterns over time.\u003cbr\u003e\nUse this section to maintain a chronological record of incidents and provide staff or administrators with a more complete overview when reviewing the individual's current support and safety needs.\u003c\/p\u003e\n\u003cp\u003eCORRECTIVE ACTION \u0026amp; SAFETY PLANNING\u003cbr\u003e\nDocument what has already been attempted and what changes may be considered going forward.\u003cbr\u003e\nThe template provides space for:\u003c\/p\u003e\n\u003cp\u003e• Previous Interventions\u003cbr\u003e\n• Current Corrective Actions\u003cbr\u003e\n• Safety Measures\u003cbr\u003e\n• Monitoring\u003cbr\u003e\n• Family \/ Responsible Party Communication\u003cbr\u003e\n• Administrative Determination\u003cbr\u003e\n• Discharge or Transition Planning\u003c\/p\u003e\n\u003cp\u003eThe existing form includes administrative options addressing whether services should continue, be monitored, or move toward discharge\/transition planning.\u003c\/p\u003e\n\u003cp\u003eCUSTOMIZABLE FOR YOUR ORGANIZATION\u003cbr\u003e\nPersonalize the template with your:\u003cbr\u003e\n• Agency or facility name\u003cbr\u003e\n• Logo\u003cbr\u003e\n• Client \/ resident information\u003cbr\u003e\n• Risk assessment procedures\u003cbr\u003e\n• Incident information\u003cbr\u003e\n• Intervention strategies\u003cbr\u003e\n• Safety procedures\u003cbr\u003e\n• Responsible-party information\u003cbr\u003e\n• Administrative review procedures\u003cbr\u003e\n• Program-specific documentation requirements\u003c\/p\u003e\n\u003cp\u003eDIGITAL DOWNLOAD\u003cbr\u003e\nThis is a digital product. No physical item will be shipped.\u003cbr\u003e\nYour purchase includes 1 PDF and 1 additional digital file.\u003c\/p\u003e\n\u003cp\u003eAfter purchase, download your files, customize the applicable sections for your organization, and use the template for ongoing unauthorized leave and elopement documentation.\u003c\/p\u003e\n\u003cp\u003eIMPORTANT DISCLAIMER\u003cbr\u003e\nThis template is provided for general administrative, informational, and documentation purposes only and does not constitute medical, behavioral health, legal, licensing, regulatory, or compliance advice.\u003cbr\u003e\nThis form does not replace an individualized clinical assessment, professional elopement risk assessment, care plan, emergency procedure, or other evaluation that must be completed by an appropriately qualified professional.\u003c\/p\u003e\n\u003cp\u003eOrganizations are responsible for establishing appropriate supervision, emergency response, notification, incident reporting, discharge, and safety procedures based on the individual's needs and applicable requirements.\u003c\/p\u003e\n\u003cp\u003ePurchasers are responsible for reviewing and customizing the template for their specific services, residents, facility type, and jurisdiction.\u003c\/p\u003e\n\u003cp\u003eDue to the nature of digital products, all sales are final.\u003c\/p\u003e","brand":"DocuBridge","offers":[{"title":"Default Title","offer_id":46989856702566,"sku":null,"price":5.99,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0736\/2586\/2246\/files\/il_fullxfull.8520266073_luts.jpg?v=1788484775","url":"https:\/\/docubridgeadmin.com\/products\/continuous-unauthorized-leave-form-15892","provider":"DocuBridge","version":"1.0","type":"link"}