Northeastern PA Health Care Quality Unit

Serving Bradford, Sullivan, Lackawanna, Susquehanna, Luzerne, Wyoming, Tioga and Wayne Counties

Frequently Used Forms

The following frequently used forms are available for your convenience.

Referral Request Form

Admittance Form for Hospital/Emergency Room

Decision Making Tool for Discharge from Hospital/Emergency Room

Assessment Tool for Comprehensive Dentistry

Managing Challenging Behaviors for Oral Care Visits


    Printable Resources (PDF format)

        EveryDay Lives
        Guardianship Services
        Representative Payee Services
        Special Needs Trust Services
        Mapping the Future Booklet
        My Voice My Choice Booklet
        Steps for Being An Effective Advocate

AID in PA is a resource collection for Pennsylvanians in the autism and intellectual disability communities.  A joint effort between ASERT (Autism Services, Education, Resources, and Training) and the statewide HCQUs (Health Care Quality Units), this site will be designed to connect individuals with disabilities, families, professionals, and community members with resources that can best serve them in emergency situations.  Current resources focus on the ongoing COVID-19 crisis.