Get 6170 Form - Dhcs Ca 2020-2025

The 6170 Form - Dhcs Ca is an essential document for preadmission screening and resident review required by federal and state regulations. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently while using online resources.

Follow the steps to complete the form effectively.

1. Click 'Get Form' button to access the 6170 Form and open it in the editing environment.
2. Begin by filling out Section I, Resident Identification, which includes personal details like first name, last name, date of birth, and identifying numbers such as Medi-Cal and Medicare numbers.
3. Proceed to Section II, Facility Completing Level I, where you will enter the name and address of the facility completing the screening, as well as contact details for the person filling out the form.
4. In Section III, answer questions related to the Mental Illness (MI) Screen: select any diagnoses applicable, indicate recent treatment history, and assess functional limitations in major life activities.
5. Move to Section IV, where you will screen for Intellectual or Developmental Disabilities (ID/DD) and related conditions, confirming any prior disabilities or current service consumption.
6. Continue to Section V to evaluate for major and mild neurocognitive disorders, detailing any relevant medical history and cognitive function.
7. In Section VI, address provisional admissions, indicating whether the resident requires protective services or respite care.
8. Complete Section VII concerning 30-day exempted hospital discharge details, including certification from the attending physician.
9. Fill out Section VIII to provide additional resident information, including gender, marital status, primary language, and insurance type.
10. In Section IX, indicate if community placement alternatives have been considered and specify reasons if they have not.
11. Address Section X concerning conservatorship and power of attorney. Provide relevant details if a conservator exists.
12. Finally, complete Section XI regarding advanced categoricals, ensuring to articulate any severe physical conditions or terminal illnesses if applicable.
13. After all sections are filled out, review the entire form for completeness and accuracy. Once confirmed, you may save changes, download, print, or share the completed form as needed.

Take charge of your documentation process and compete your 6170 Form online today.