Get 701t Non-community Placement Assessment - Department Of Elder - Elderaffairs State Fl

Filling out the 701T Non-Community Placement Assessment is a crucial step for individuals seeking assistance from the Department of Elder Affairs in Florida. This comprehensive guide will provide you with user-friendly instructions to complete the assessment online effectively.

Follow the steps to complete the assessment correctly.

1. Press the ‘Get Form’ button to access and open the 701T Non-Community Placement Assessment in your preferred online editor.
2. Begin with the demographic section by filling in your Social Security number, name (including first, middle initial, and last), and Medicaid number. Also, provide your phone number and date of birth in the specified format (mm/dd/yyyy).
3. Indicate your sex, race, ethnicity, and primary language by selecting the relevant options. Pay attention to the question regarding limited ability in reading, writing, speaking, or understanding English, and answer accordingly.
4. Complete the marital status section, selecting from married, partnered, single, separated, divorced, or widowed, as applicable.
5. Provide your current physical location address. If you are in a facility, please include the facility name and select the type (private residence, adult day care, assisted living facility, nursing facility, etc.). If your home address is different, fill that section in as well.
6. Fill in the assessment date, assessment site, and referral date. Provide the referral source and relationship, and indicate if there is an imminent risk of nursing home placement.
7. Answer questions about your living situation and whether someone other than the client is answering questions. Carefully fill in the memory section, checking if you have any cognitive impairments or memory loss.
8. In the general health section, report any falls in the past six months and any emergency room visits or hospital admissions in the last year.
9. Detail the level of assistance needed for activities of daily living, specifying tasks such as bathing, dressing, and eating. Move on to the instrumental activities of daily living section to assess help needed for tasks like shopping and managing medications.
10. Complete the health conditions section by marking any past or current health conditions as instructed. Provide information about any therapies currently being undertaken.
11. Fill in the mental health section by answering questions regarding emotional well-being and any diagnosed conditions. Report on observed problem behaviors if necessary.
12. Address the nutrition section, noting any recent weight changes and dietary requirements. Lastly, complete the medications section with details about any prescribed or over-the-counter medications, and list the physicians you usually consult.
13. Once all fields are filled out accurately, save changes to the document. You may then download, print, or share the completed form as needed.

Complete your 701T Non-Community Placement Assessment online today to ensure timely assistance.