Assessement form for mental retardation 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part A, where you will verify your choice of Home- and Community-Based Services (HCBS) or Medical Institutional Services. Select your choice and provide the signature of the consumer or guardian along with the date.
3. Proceed to Part B, starting with the Initial Review or Continued Stay Review. Fill in essential details such as Social Security Number, Medicaid number, Consumer Name, and County of Support.
4. Complete demographic information including Birth Date, Sex, Race/Ethnicity, and details about the HCBS Certified Agency providing services.
5. Document any diagnoses and ensure that mental retardation is included among them. Provide information on medications and living arrangements within the HCBS/MR program.
6. In subsequent sections, check categories that describe independent skills and deficits across various life activities such as ambulation, self-help skills, domestic skills, etc. Be thorough in your assessments.
7. Finally, ensure all required signatures are obtained from QMRPs or case managers certifying the accuracy of the information provided.

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