Follow the steps to complete the assessment report thoroughly.

1. Click ‘Get Form’ button to obtain the assessment report and open it in your preferred editing platform.
2. Begin by filling in the recipient’s details. Enter the recipient’s name, date of birth, Medicaid ID number, current address, phone number, and the provider agency’s name.
3. Specify the assessment type by checking the appropriate box for either initial visit, routine visit, or six-month re-assessment.
4. Complete the functional status section. For each activity of daily living (ADL), indicate the level of assistance required by selecting the corresponding option.
5. In the medical and nursing information section, provide details about the recipient’s diagnoses, medications, health status, current medical nursing needs, therapies, and any hospitalizations.
6. Document the support system utilized by the recipient. List any waiver services, total weekly care hours, and the primary caregiver's information.
7. If applicable, fill out sections specific to either consumer-directed or agency-directed services, providing additional details as required.
8. Ensure that the supervisory visit details are accurately recorded, including the frequency of visits and any issues with care provision.
9. Review all sections for completeness and accuracy before saving your changes. If necessary, you can download, print, or share the report once completed.

Get started on filling out the Community-Based Care Recipient Assessment Report online today.