After completion of all items in Sections 1 and 2 (pages 1 – 4), return this form to the facility at the address indicated above. SECTION 1. Health Assessment. NOTE: This section must be completed by a licensed health care provider and must include a face-to-face examination and interview with the resident. 1. Health Assessment (continued)

Proceed to complete a community based assessment using the attached or a form which has received prior approval from the Section for Long Term Care Regulation.

Self-Care and General Oversight Assessment - Medications A. Attach a listing of all currently prescribed medications, including dosage, directions for use, and route. B.

Finding the right assisted living facility to match your current needs with the care services provided is the very first step. By assessing the current needs and how those needs may evolve over time, gives you the best starting point to gain clarity and …

Housekeeping: Identify the level of assistance needed to attend to housekeeping tasks, clean surfaces, living quarters. Night Needs: Identify the level of assistance needed at night and/or nightly checks. Health Services: Identify the level of assistance needed to arrange for own health and supportive services.

AL Type I Residents are provided limited assistance with Activities of Daily Living, and social care in a residential setting. others with more than three ADLs. A Type I facility may accept and retain residents who meet the following criteria: (1) are. through contract or by the facility, if permitted by facility policy. of Health rule.

Jul 15, 2024 · The Assisted Living Assessment form is a multifunctional tool that aligns with various healthcare needs. Its comprehensive nature ensures that it can be used in diverse scenarios, providing a guideline for practitioners.

Assisted Living FacilityAn assisted living facility (ALF) is designed to provide personal care services in the least restrictive and most home-like environment. ... Application and Forms. Assisted Living Facility Licensing Application ; ... Resident Health Assessment for Assisted Living Facilities, AHCA Form 1823, April 2021 [ 70.1 kB ...

Ensure thorough and personalized care for your residents or patients with this comprehensive assessment form! With a user-friendly design spanning three PDF pages, this assessment covers all essential areas to help you tailor care plans and enhance the overall well-being of those under your care. 📋 Simply download the PDF form.