You can always press Enter⏎ to continue
Community Homes Visitation Request Form

Community Homes Visitation Request Form

Please fill out and submit this form to our Community Homes visitation office.  
31Questions

HIPAA

Compliance

  • 1
    Press
    Enter
  • 2
    • Bird Ave
    • Blackstone
    • Broad St
    • Cook St
    • Earlville
    • Ford Ave
    • GlensBridge
    • Grandview
    • Hayes St
    • Johnston Circle
    • Kelly Corners
    • Lakeside
    • Milford
    • Morris
    • Mountainside
    • Nichols
    • Oak and Elm
    • Otego
    • Oxford
    • Parkview
    • Pierstown
    • Pine Creek
    • Pines
    • Sherburne
    • Stone Quarry Rd
    • Swart Hollow
    • Sweet Briar
    • Walnut St
    • West Oneonta
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Press
    Enter
  • 8
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    Press
    Enter
  • 11
    -
    Pick a Date
    Press
    Enter
  • 12
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 13
    -
    Pick a Date
    Press
    Enter
  • 14
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 15
    -
    Pick a Date
    Press
    Enter
  • 16
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 17
    -
    Pick a Date
    Press
    Enter
  • 18
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 19
    -
    Pick a Date
    Press
    Enter
  • 20
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 21
    -
    Pick a Date
    Press
    Enter
  • 22
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 23
    -
    Pick a Date
    Press
    Enter
  • 24
    9:00 AM - 9:00 PM
    • 9:00 AM
    • 9:30 AM
    • 10:00 AM
    • 10:30 AM
    • 11:00 AM
    • 11:30 AM
    • 12:00 PM
    • 12:30 PM
    • 1:00 PM
    • 1:30 PM
    • 2:00 PM
    • 2:30 PM
    • 3:00 PM
    • 3:30 PM
    • 4:00 PM
    • 4:30 PM
    • 5:00 PM
    • 5:30 PM
    • 6:00 PM
    • 6:30 PM
    • 7:00 PM
    • 7:30 PM
    • 8:00 PM
    • 8:30 PM
    • 9:00 PM
    Press
    Enter
  • 25

    COMMUNITY HOMES VISITS


    In response to the reduction in COVID-19 infections across the state, Springbrook has updated our visitation protocols. In keeping with updated OPWDD mandates and for the benefit of your loved one and the loved ones of others, we thank you for your cooperation as we implement the following updated visitation protocol, effective Friday, March 11, 2022:
     
    Individuals who have been fully vaccinated should not be prohibited from visiting on or offsite as a result of exposure to COVID-19, so long as they remain asymptomatic. Fully vaccinated, for purposes of this guidance, is defined as being 2 or more weeks after the final dose (e.g., first for Janssen/Johnson & Johnson, second for Pfizer and Moderna) of the vaccine approved by the FDA or authorized by the FDA for emergency use.
     
    OVERNIGHT VISITS - COMMUNITY HOMES
     
    Overnight visitation is permitted for fully vaccinated residents. Overnight visitation for unvaccinated residents is permitted unless the individual is quarantined because of a COVID-19 exposure.
     
    I understand and attest to the following: 

    • In-home visits are permitted unless any residents who live in your loved one's home is in isolation or quarantine.
    • In-home visits should occur in single bedrooms. Visitors must remain in the resident’s room throughout the visit except when directed by staff to leave.
    • Overnight and day visits will also remain in effect 
    • Per OPWDD, visits must be scheduled in advance.
      • Starting Monday, January 10 use the centralized scheduling form on Springbrook's website to schedule your visit at least 48 hours in advance. Do not contact your loved one's home or other Springbrook staff to schedule, they will direct you to the Scheduling Request Form
    • This policy will be reassessed every 30 days.

     

    • Starting, Friday, January 14, community homes residents returning to Springbrook from an overnight visit of any length must take a COVID-19 test prior to entering their Springbrook home.
      • Springbrook will provide an antigen self-test kit upon arrival to the Community Home 
      • One (1) of the two (2) tests in the kit should be administered in the car

     

    • Family will then communicate test results to Springbrook staff
    • If negative - the visit drop-off will proceed as usual 
      • The second test from the kit will be administered by the house nurse 36-72 hours after the first test
    • If positive - The family will be given the option to return home with their loved one and the resident will remain with the family for the extent of their quarantine period, or proceed with the drop-off and the resident will quarantine at Springbrook.
    • If the resident is returning to the house, follow all quarantine procedures. The second test from the kit will be administered by a nurse 36-72 hours after the first test.
      • If the resident returns home with family, instruct the family to administer the second test 36-72 hours after the first test


    • Prior to each scheduled visit, visitors must undergo symptom and temperature checks by facility staff and shall be denied visitation if they report any COVID-19 exposure or symptoms during the prior 14 days, or have a temperature over 100.0 degrees Fahrenheit;
    • Visitors must be provided a face mask if they do not arrive with one and that mask must be properly worn while on-site


    I understand that failure to follow the process as outlined in this document may compromise the approval of future visits.  

    I,            am acknowledging that I have read and agree to abide by the above policy on   Pick a Date         

         

    Press
    Enter
  • 26

    COMMUNITY HOMES VISITS


    For the benefit of your loved one and the loved ones of others, Springbrook thanks you for your cooperation as we implement the following updated visitation protocol, effective Friday, March 11, 2022:
     
    Individuals should not be prohibited from visiting on or offsite as a result of exposure to COVID-19, so long as they remain asymptomatic and the house is not under quarantine or isolation.
     
    OVERNIGHT VISITS - COMMUNITY HOMES
     
    Overnight visitation is permitted for all residents.
     
    I understand and attest to the following: 

    • In-home visits are permitted unless any residents who live in your loved one’s home is in isolation or quarantine
    • In-home visits are no longer restricted to the resident’s room and should be no longer than 2 hours
    • In keeping with Springbrook’s organization-wide mask policy for in-home visits, unvaccinated visitor(s) must wear a Springbrook provided KN95 mask
    • Vaccinated visitors are required to wear a surgical mask for in-home visits, which will also be provided by Springbrook
    • Overnight and day visits must continue to be scheduled using the centralized scheduling form on Springbrook’s website. All visits must be scheduled at least 48 hours in advance. Do not contact your loved one’s home or other Springbrook staff to schedule, they will direct you to the Scheduling Request Form

     

    • Starting, Friday, March 11, community homes residents returning to Springbrook from an overnight visit of more than 3 nights must take a COVID-19 antigen test prior to entering their Springbrook home.
      • Springbrook will provide an antigen self-test kit upon arrival to the Community Home 
      • One (1) of the two (2) tests in the kit should be administered in the car

     

    • Family will then communicate test results to Springbrook staff
    • If negative - the visit drop-off will proceed as usual 
      • The second test from the kit will be administered by the house nurse 36-72 hours after the first test
    • If positive - The family will be given the option to return home with their loved one and the resident will remain with the family for the extent of their quarantine period, or proceed with the drop-off and the resident will quarantine at Springbrook.
    • If the resident is returning to the house, follow all quarantine procedures. The second test from the kit will be administered by a nurse 36-72 hours after the first test.
      • If the resident returns home with family, instruct the family to administer the second test 36-72 hours after the first test

    Prior to each visit, visitors must undergo a symptom and temperature check. Report of symptoms or temperature above 100.0 will result in the visit being rescheduled.
    I understand that failure to follow the process as outlined in this document may compromise the approval of future visits.  

    I,     *     *    am acknowledging that I have read and agree to abide by the above policy on   Pick a Date *      *    

    *      

    Press
    Enter
  • 27
    Press
    Enter
  • 28
    Press
    Enter
  • 29
    Press
    Enter
  • 30
    Press
    Enter
  • 31

    Springbrook recommends:

    1. Offsite visits take place at home or outdoors.
    2. A face mask for the student/resident and all members of my household (including myself) anytime they are away from the home during an offsite visit.
    3. That any dining outside of the home occur in restaurants that enforce all NYS COVID-19 health and safety mandates.
    Press
    Enter
  • 32
    Please share any additional notes for your visit below.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 33

    By clicking Submit, I verify the accuracy of the information contained in this form.

    Press
    Enter
  • Should be Empty:
Question Label
1 of 33See AllGo Back
close