Adult family home disclosure 2026

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4.4 out of 5

113 votes

The document is a disclosure form for Adult Family Homes, required by Washington state law (RCW 70.128.280), outlining the charges and services provided by the home. It includes information on Medicaid policies, admission fees, deposits, prepaid charges, daily/monthly rates, personal care services, medication assistance, and additional fees for various items and activities. The form emphasizes the importance of direct communication with the home for potential residents and their families to ensure they understand all costs and services available.

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Click ‘Get Form’ to open the Adult Family Home Disclosure in the editor.
Begin by entering the HOME/PROVIDER’S NAME and DATE at the top of the form. This identifies the specific adult family home you are reviewing.
Fill in the LICENSE NUMBER, which is essential for verifying the home's legitimacy.
Review each section carefully, starting with Medicaid Information. Ensure you understand how Medicaid payments apply to services and any conditions that may affect eligibility.
Proceed to Admission Fees, Deposits, and Prepaid Charges. Clearly document any fees required by the home, including their purposes and amounts.
Complete sections on Daily and/or Monthly Rates, Personal Care, Medication Services, Other Services, Items, Activities, and Other Charges. Be thorough in noting any additional comments or specifics related to charges.

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See more adult family home disclosure versions

We've got more versions of the adult family home disclosure form. Select the right adult family home disclosure version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (151 Votes)
2015	4.2 Satisfied (23 Votes)
2015	4.4 Satisfied (113 Votes)

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