Get Community Care Licensing Physicians Report

Filling out the Community Care Licensing Physicians Report is a critical process that ensures proper care for residents in community care facilities. This guide provides a step-by-step approach to assist users in accurately completing the form online.

Follow the steps to successfully complete the Community Care Licensing Physicians Report.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the facility information. Fill out the name, address, and telephone number of the facility, ensuring accuracy as this information is vital for correct identification.
3. Continue to the licensee information section. Enter the name and telephone number of the licensee, as well as the facility license number, which is essential for recordkeeping.
4. Next, move on to the resident/client information. Include the name, address, telephone number, next of kin details, social security number, and the person responsible for the resident’s finances.
5. For the patient's diagnosis section, enter primary and secondary diagnoses as assessed by the physician, along with the patient’s age, height, weight, and the length of time they have been under care.
6. Indicate whether the individual requires skilled nursing care by selecting yes or no. Complete the tuberculosis examination results, providing details about the test and its date.
7. Document any treatment or medication the resident is receiving, along with information about other contagious or infectious diseases, if applicable.
8. In the ambulatory status specification, select 'ambulatory' or 'nonambulatory' based on the resident’s ability to leave a building unassisted during emergencies.
9. Assess the physical and mental health status of the resident. Check the appropriate boxes indicating their condition regarding auditory and visual impairments, dietary issues, or any substance abuse problems.
10. Evaluate the capacity for self-care by indicating whether the resident can manage personal needs and administer their medications or needs constant medical supervision.
11. List over-the-counter medications permissible for the resident, along with their respective conditions. Additionally, provide details of any current prescribed medications.
12. Finish by filling in the physician’s name and address, telephone number, and signing the form. Ensure the date of completion is accurate, as this documentation is important for the licensing agency.
13. Authorize the release of medical information by completing the authorization section. Provide the patient's name and the name and address of the licensing agency, along with the signature of the authorized representative.
14. Once all sections are complete, review the entire form for accuracy, then save changes, download, print, or share the completed report as needed.

Complete the Community Care Licensing Physicians Report online to ensure timely and accurate submission.