FHC Forms

Feel free to download and use these forms as you need them.  Let us know if you need help filling them out.

Back to the Portal


Our software ClearCare will automatically calculate mileage and travel time.  You can also report "errand" miles through the telephony component of ClearCare.  You may also continue to report mileage and travel time not covered in these two functions using the same online form we have used in the past.

Additional Travel Time and  Mileage Report


The Availability form can be found: HERE

The PTO Request form can be found: HERE

IPCed Opt in/Opt out form: HERE

Request a P3 Star Advancement: Here


Use this form to report an on-the-job injury.

This is the monthly "care sheet" for state reimbursed clients

Use this form to submit a change to your availability. 

Use this form to submit a request for using your Vacation and Sick time. 

Use this form to gain access to or drop access to IPCed 

Use this form to request that HR review your completion of the next star level