Get In Sf 48896 1998-2025

The IN SF 48896 form is a crucial document required by Indiana Code 12-10-5.5 for facilities providing Alzheimer's and dementia special care. This guide will help you understand the form's components and provide clear, step-by-step instructions on how to complete it accurately.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the name of the facility in the designated field. Specify whether the facility is for profit or non-profit by checking the appropriate box.
3. Enter the contact information, including the telephone number, address, fax number, and email address of the person completing the form.
4. Provide the date of completion by entering the month, day, and year. Next, fill in the name of the owner and the county where the facility is located.
5. Indicate the total number of beds in the program/unit, as well as the number of Medicaid certified beds, and total number of beds in the balance of the facility.
6. If your facility has multiple Alzheimer's/Dementia Special Care Programs, indicate whether you have submitted additional disclosure forms and provide the total number submitted.
7. Answer the accreditation question by selecting yes or no regarding the program/unit's accreditation by the Joint Commission on the Accreditation of Health Care Organizations.
8. Next, complete the mission philosophy section by indicating whether your program/unit has a statement regarding the needs of residents with Alzheimer's or related disorders.
9. Proceed to the admission, transfer, and discharge process, indicating if there are formal written processes in place and detailing any specific criteria involved.
10. Continue filling out the plan of care section by addressing the frequency of care plan reviews and the composition of the care planning team.
11. Complete the staffing patterns section, providing ratios of direct care staff to residents for each shift and specifying the number of full-time equivalent staff members.
12. In the unit design features section, answer questions relating to safety, accessibility, and the environment designed specifically for individuals with Alzheimer's or dementia.
13. Fill in the frequency and types of activities provided for residents, ensuring to include details about the activity director and the therapeutic methods used.
14. Outline any family support services available, as well as guidelines for using physical and chemical restraints.
15. Lastly, provide information about any entrance fees and the base daily rate for services, listing any supplementary services as needed.
16. Once all sections are completed, review the information for accuracy. Save your changes, and ensure to download, print, or share the form as required.

Complete your document online today and ensure compliance with Indiana regulations.