Get Ny Doh-5176 (dss 2900) 2015-2026

The NY DOH-5176 (DSS 2900) form is essential for reporting daily resident census in adult care facilities. This guide provides step-by-step instructions to effectively complete the form online, ensuring compliance and accuracy in your reporting.

Follow the steps to fill out the NY DOH-5176 (DSS 2900) online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the 'Facility Name' in the designated field to identify your care facility clearly.
3. Fill in the 'Operating Certificate Number' associated with your facility to ensure compliance with state regulations.
4. Input the 'ACF Capacity', which represents the maximum number of residents your facility can accommodate.
5. Complete the section for 'Resident’s Name' by entering the full name of each resident being reported.
6. Indicate the 'Level of Care' for each resident by checking all applicable boxes: AH, EHP, ALR, EALR, SNALR, or ALP.
7. Record the 'Room #' where the resident is located for accurate tracking.
8. Fill in the month and year at the top of the form to specify the time period of the report.
9. Record the 'Date' of the report to maintain a clear record timeline.
10. If a resident is absent, indicate the appropriate code in the date box: H for Hospital, V for Home Visit/Vacation, M for Missing, or O for Out or Other.
11. Complete the 'Days of Care' section by marking occupied days over the reporting period, summing totals as necessary.
12. Once all sections are completed, review your entries for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your documents online today for a streamlined reporting process.