Locet form louisiana 2026

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The document is a Louisiana Department of Health and Hospitals (DHH) Nursing Facility Client Face Sheet used for the Level of Care Eligibility Tool (LOCET) in the nursing facility admission process. It includes sections for client identification, demographic information, eligibility determination procedures, and assessments of the applicant's medical needs and functional abilities. The form collects detailed information about the applicant's health status, daily living activities, cognitive performance, physician involvement, treatments received, and behavioral observations to determine eligibility for long-term care services.

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Click ‘Get Form’ to open the locet form in the editor.
Begin by entering the Client’s Name and Social Security Number in Section A. Ensure accuracy as this information is crucial for identification.
Proceed to fill out the Medicaid and Private Insurance details, if applicable. This section helps determine eligibility for services.
In Section C, select the appropriate Gender and Race/Ethnicity options. This data is essential for demographic purposes.
Complete the Client Contact Information section, including Home Address and Telephone number. If there’s a different mailing address, provide that as well.
For Section D, indicate any Other Contact Information relevant to the applicant's care. Specify their relationship to the applicant.
Continue through each pathway of the form, providing detailed responses regarding Activities of Daily Living and Cognitive Performance as required.

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