Get Dementia Special Care Unit (dscu) Disclosure Form

Completing the Dementia Special Care Unit (DSCU) Disclosure Form online is an important task for facilities to ensure compliance and transparency regarding their services. This guide provides clear instructions to help you navigate each section of the form easily and effectively.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the facility name in the designated field to identify your organization.
3. Fill in the unit name(s) if applicable, along with the address, town or city, and zip code of the facility.
4. Provide the DPH license number and the total number of beds available in your facility.
5. Input the contact phone number and specify the facility totals related to residents inside and outside the DSCU.
6. Document the ratio of staff to residents on the DSCU, indicating staffing levels for weekdays and weekends for each shift.
7. Indicate whether essential services such as dental care, occupational therapy, and mental health services are available within the facility.
8. Record the hours of therapeutic activities offered for each shift throughout the week.
9. Answer whether activities are provided 24 hours a day for residents who require them.
10. Address the DSCU policies, programs, and physical environment features by answering yes or no to each question provided in the form.
11. If applicable, note any requests for waivers from DSCU regulations and attach copies of those requests.
12. Enter your facility contact information, including name, phone number, and email address for any additional inquiries.
13. Provide the typed name, license number, and signature of the facility administrator, along with the date to ensure the accuracy of the information.
14. Review all entered information for accuracy before submitting to ensure compliance with regulations.
15. Save any changes, download the form, and consider printing or sharing it as needed.

Complete your Dementia Special Care Unit (DSCU) Disclosure Form online today to ensure compliance and provide valuable information to your residents.