Get G: Connie Stephanie Clapp Form 007transcert.wpd - Elderaffairs State Fl

This guide provides a comprehensive walkthrough for users on how to fill out the G: CONNIE STEPHANIE CLAPP Form 007transcert.wpd, an essential document for elder affairs in Florida. By following the instructions outlined below, users can confidently complete the form online, ensuring all necessary information is accurately captured.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form. This will allow you to obtain the necessary document and open it in an online editor.
2. Begin by filling out the demographic section. Provide the assessor or case manager's name, provider ID, and signature. Then, complete the assessment purpose, indicated by checking the appropriate box for initial, annual, or other assessments.
3. Next, enter the user's social security number, full name (first, middle initial, and last), and if applicable, their Medicaid number and phone number.
4. Complete the date of birth, selecting the appropriate sex, race, and ethnicity from the options provided. Indicate the primary language spoken and check if there is any limited ability to read, write, or understand English.
5. Fill in the current physical location address, include the type of residence (such as a private residence, nursing facility, etc.), and provide any additional addresses if applicable.
6. Continue by completing the assessment date and site, referral date, and source. Answer questions related to the user's living situation, income, and assets.
7. Move on to the health, memory, and communication impairment sections. Users should assess their overall health, frequency of falls, and access to medical care.
8. Fill out the activities of daily living section, noting the level of assistance needed for each task, from bathing to mobility.
9. Address the instrumental activities of daily living section and specify any help required with tasks such as managing money and shopping.
10. Complete the sections on health conditions, therapies, and mental health, indicating any conditions and the type of support needed.
11. Once all sections are completed, review the information for accuracy. Save the changes, download the completed form, print it for submission, or prepare to share it as required.

Start filling out your document online today to ensure timely assessment and assistance.