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Notes FORM CMS-20050 06/07 B Resident Observation Choices QP234 1 Are you able to participate in making decisions regarding food choices/ preferences No Yes skip to 3 2 Is this acceptable to you Yes 3 Do you participate in choosing your bedtime up 7 Do you choose your dressing and bath schedule Cleanliness/Grooming/Oral QP075 QP216 1 Based on general observations did you see any of the following Mark all that apply a Unpleasant body odor other th.

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  1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin by entering the facility name, facility ID, date, surveyor name, resident name, resident ID, admit date, and resident room in the designated fields. Ensure all details are accurate to avoid any discrepancies.
  3. In the resident interview section, assess whether the resident is interviewable by marking the appropriate option. If the resident refuses or is unavailable, proceed to the resident observation section.
  4. Continue through the resident interview questions. Use clear and supportive language to gauge the resident’s participation in decision-making regarding their care and preferences.
  5. Move on to the resident observation section, marking any observations related to cleanliness, dignity, and overall care standards as outlined in the prompts.
  6. As you complete each section, ensure that feedback and comments are entered in the provided space for relevant observations.
  7. Once all sections are complete, review your entries for accuracy. Save your changes within the form.
  8. Lastly, download, print, or share the completed form as needed, ensuring all information is securely handled.

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