Florida 1823 assisted living form-2026

1. Click ‘Get Form’ to open the Florida 1823 Assisted Living Form in our editor.
2. Begin by filling out the Resident Information section, including the resident's name, date of birth, and authorized representative if applicable.
3. Next, complete the Facility Information section with details such as facility name, telephone number, address, and contact person.
4. Proceed to Section 1: Health Assessment. This must be filled out by a licensed health care provider. Include known allergies, height, weight, medical history, and any physical or sensory limitations.
5. In Section 1B, indicate the level of assistance needed for activities of daily living using the provided key (I = Independent, S = Needs Supervision, A = Needs Assistance, T = Total Care).
6. Complete Section 2 regarding medications. Attach a list of prescribed medications and indicate if assistance is needed for self-administration.
7. Finally, ensure that the medical examiner's information is completed at the end of the form before submitting it back to the facility.

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