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E, Uniform Comprehensive Assessment, Part I, Intake and Referral. Numbers in parenthesis refer to item numbers in the Oklahoma Long-Term Care Authority (OLTCA) Manual. (1) Consumer name Date Social Security number (2) (3) Location of: Case number assessment consumer's residence hospital Unique ID number reassessment relative's home other, specify nursing home Mental status questionnaire (MSQ) (Assessor) Write responses to questions. Do not score until section is completed. Count one error.

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How to fill out the OK Form 02HM001E online

This guide provides a comprehensive overview of filling out the OK Form 02HM001E online. Whether you are familiar with legal documents or a first-time user, this step-by-step guide will assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the OK Form 02HM001E online.

  1. Click the 'Get Form' button to obtain the form and open it in the online editor.
  2. Fill in the consumer's name, date, and Social Security number in the designated fields. Ensure this information is accurate as it is critical for processing.
  3. Indicate the location of the assessment, selecting from options such as the consumer's residence or a hospital. Provide any applicable case numbers.
  4. Complete the mental status questionnaire by writing responses to the questions as instructed. Be mindful of the scoring system and do not score until all questions are completed.
  5. Proceed to the health assessment section. Check the source of information used and ask the consumer about their health conditions, documenting each condition as necessary.
  6. Continue filling out the sections regarding drug, alcohol, and tobacco use. Specify any medications used and document the pharmacy details.
  7. Complete the functional assessment sections by checking sources of information, indicating levels of assistance needed for daily living activities.
  8. Fill in the consumer support, social resources, and mental health sections carefully, providing as much detail as necessary to reflect the consumer's situation.
  9. In the caregiver assessment, provide information about the caregiver’s involvement, including how often they assist and what kind of assistance is provided.
  10. After all fields are filled, review the form for accuracy. Make necessary corrections to ensure completeness.
  11. Once satisfied with the entries, users can save changes, download a copy, print the form, or share it as required.

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