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MUI/UI Links:

UI MUI Form - Complete UI form and send to ui@muskingumdd.org.
MUI Annual Review Form- Independent Provider - Independent providers are required to complete the Annual Review by January 31 and send to the County Board by February 28 via ui@muskingumdd.org email.
DODD MUI UI Information- An overview of what a UI/MUI are, Explanation of Roles (Provider, County Board and DODD, and DODD’s reporting process).  
Monthly UI Report Log- Each provider will review their log of all unusual incidents as necessary, but no less than monthly, to ensure appropriate prevention plans have been implemented and identified trends and patterns have been addressed as appropriate. When no unusual incidents occur during a calendar month, the provider will make a notation to that effect on its log of unusual incidents. Submit UI logs, as trends and patterns have been identified, to the ui@muskingumdd.org email. 
MUI Interpretive Guidelines-  This document gives more details about each type of MUI including definitions, prompts, and examples.
Appendix C- Law Enforcement Involvement Form- This form needs to be filled out when a person has been tased by law enforcement, arrested, charged, or incarcerated.
Appendix D- Unanticipated Hospitalization Form- This form needs to be filled out when a person is with a provider and hospitalized for more than 48 hours and diagnosed with one of the listed diagnoses in rule or when the person has been re-admitted within 30 days for the same diagnosis. 
Appendix E- Unapproved Behavior Support Form- This form needs to be filled out when the use of a restrictive measure is implemented without approval of the human rights committee or without informed consent from the person or the person's guardian.

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Muskingum County Board of Developmental Disabilities

1304 Newark Rd Zanesville, OH 43701

T: 740-453-4829

F: 740-455-4183

Emergency On-Call 1-888-905-0787

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