195 McGregor Street, Unit 400
Manchester, NH 03102
Residential Case Management Agreement
Client Name: Client Code:
IT IS AGREED by the undersigned that each resident with developmental impairment shall receive
services by a Case Manager employed by The Moore Center unless such resident refuses to consent to the
assignment of a Case Manager.
AND, that the residence administrator or his/her designee shall participate, with the Case Manager, in the
development of a residential service plan and that the residence administrator shall ensure implementation
of a plan as written.
AND, that the residence staff and/or family shall not serve as the legal guardian of any resident within
their own residence.
AND, that any placement of a person into the community residence shall receive prior approval from the
Signature, Residential Administrator / Designee Date
Print Name, Residential Administrator / Designee
Signature, Case Manager / Designee Date
Print Name, Case Manager / Designee
Residential Case Management Agreement 2011/06/17 CR-089