Follow the steps to fill out the assessment form online.

1. Press the ‘Get Form’ button to access the MI AmeriHealth Caritas Care For Older Adults Assessment Form. This will open the form in your editing interface.
2. Begin by entering the patient’s details in the first section. This includes the patient’s name, date of birth, member ID number, and phone number.
3. Fill in the provider's information, including their name and phone number.
4. In the Pain Assessment section, indicate whether or not the patient is experiencing pain by selecting ‘Yes’ or ‘No’. Then, have the patient rate the intensity of their pain on a scale from 0 (no pain) to 5 (severe pain). Additionally, check if the pain is constant and whether it limits daily activities.
5. Document how often the pain has prevented the patient from engaging in activities they enjoy over the past three months, selecting from the provided options.
6. In the Functional Status Assessment section, assess the patient’s ambulation, vision, hearing, and speech. Choose the appropriate status for each category and include any necessary notes about assistive devices if applicable.
7. Navigate to the Medication Review section. Enter the date of the medication review and list the medications with necessary details, including quantity, prescriber, and any relevant notes.
8. In the Advance Care Planning section, provide the date reviewed and details about discussions regarding life-sustaining treatment or advanced directives. Indicate whether documents such as advanced directives and living wills are present and if discussions with family or caregivers have occurred.
9. Finally, fill in the provider’s name, obtain their signature, and indicate the date the Pain, Functional Status, and Advance Care Planning were assessed.
10. Once all sections are completed, save changes to the form. You may choose to download, print, or share the document as required.

Complete the MI AmeriHealth Caritas Care For Older Adults Assessment Form online today to support quality care.