BASIS Tracking Logs
The following downloadable files
are examples designed by the Cottonwood CDDO for use in tracking
behaviors and seizures to serve as documentation for the BASIS
Assessment. In order
to capture behaviors in the BASIS
assessment there must be documented proof
of their occurrence.
These forms
or something similar should be used to document
behaviors in all settings (Home, Community, School, Day services,
Job, etc.)
NOTE: Behavior Tracking is not necessary for individuals with a
Tier 1-5, who are
also not currently recieving HCBS funded Day, Residential or In-Home Supports. An annual BASIS re-evaluation will not be completed on these individuals until
funding is offered. If you have any questions about whether or not you should be
tracking behaviors contact your Case Manager or the CDDO.
Behavior Trackings:
12 page version:
PDF
/ Excel
(One page per month, provides a Month-at-a-Glance View)
4 page version:
PDF /
Excel
(2 pages front & back
that provides a Year-at-a-Glance View)
2 page version:
PDF /
Excel
(Very compact 1 page front and back version, Year-at-a-Glance View)
Large print version:
PDF
(Half a month per page, large print
version)
Fax version:
PDF /
Excel
(Printable PDF file designed to be easier to read for faxing
purposes)
Versión Española:
PDF
(Registro del comportamiento en español)
Behavior Definitions
PDF
(Descriptions of each behavior)
Seizure Tracking:
1 page version:
PDF /
Excel
(One page per
year, Seizure frequency tracking log for the BASIS
Assessment).