Get Da 124 C

Filling out the DA 124 C form is an essential step in the pre-admission screening process for individuals seeking admission to nursing facilities. This guide provides a clear, step-by-step approach to effectively complete the form online, ensuring a smooth submission process.

Follow the steps to successfully complete the DA 124 C form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the person’s legal name in the designated field. Ensure it matches official records to avoid processing delays.
3. Complete the education level section by indicating the highest level of education achieved by the individual.
4. Provide information regarding prior occupation, including any jobs held before retirement or disability.
5. Record the nursing facility's legal name, including any relevant licensing information.
6. Specify the date the person was admitted to the nursing facility. If applicable, also include the discharge date.
7. List the legal guardian or contact person responsible for the individual. This must correspond to signatures later in the application.
8. Document the date of the last medical exam and any recent medical incidents that may relate to the care needs.
9. For medications, include details such as dosage and frequency. Ensure this aligns with the client’s medical diagnoses.
10. Provide detailed explanations for assessed needs, including specific types of care required, rather than vague descriptions.
11. Ensure all sections are filled accurately and legibly. Double-check for any missing information or signatures.
12. Sign and date the application at the end, including contact information for follow-up.
13. Once completed, you can save, download, print, or share the form as needed for submission.

Complete the DA 124 C online to streamline the pre-admission screening process.