Get Odh Form 613

Filling out the Odh Form 613 is an essential step for facilities providing specialized care for individuals with Alzheimer's disease or related disorders. This guide aims to provide a clear and supportive step-by-step approach to completing the form online.

Follow the steps to effectively complete the Odh Form 613.

1. Click ‘Get Form’ button to obtain the form and open it in the designated online editing environment.
2. Begin by entering your facility's name in the provided field. This identifies the specific establishment that provides care for individuals with Alzheimer's disease or related disorders.
3. Fill in the license number of your facility accurately. This information helps validate your facility’s compliance with state regulations.
4. Provide the telephone number for your facility. Make sure to include any area codes to ensure proper communication.
5. Enter the complete address of your facility. This information is crucial for anyone seeking to locate your services.
6. Specify the name of the administrator responsible for the facility, along with the date the disclosure form was completed.
7. Indicate who completed the form, including their title, to establish accountability for the information provided.
8. Document the number of beds dedicated to Alzheimer-related care and any maximum participant limits for adult day care services.
9. Each service offered should be clearly marked as yes or no, indicating whether it is included in the base rate or if it incurs additional costs.
10. Provide detailed explanations where necessary, such as on the admission, discharge, and planning processes, ensuring all fields are comprehensively addressed.
11. Review all entries for accuracy, ensuring that any additional comments or requirements are included as necessary.
12. Once completed, users can save changes, download the form for their records, print it, or share it as needed.

Complete your Odh Form 613 online today to ensure compliance and clear communication regarding care services.