Bcal 3265-2026

The document outlines the assessment plan required for residents in Adult Foster Care (AFC) facilities, as mandated by the Michigan Department of Licensing and Regulatory Affairs. It details the responsibilities of the licensee to complete a written assessment covering social, behavioral, self-care, health care, and participation in activities. The form includes sections for evaluating various needs and planning actions to address them, along with medical information and consent for release of information. The goal is to ensure appropriate care and compliance with licensing rules.

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Click ‘Get Form’ to open the bcal 3265 in the editor.
Begin by entering the resident's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
Proceed to the Social/Behavioral Assessment section. For each item listed, check 'Yes' or 'No' and provide a detailed description of needs if 'No' is selected.
Move on to the Self Care Skill Assessment. Again, indicate whether assistance is needed for each skill and describe how those needs will be met if applicable.
In the Health Care Assessment section, check off any relevant health concerns and provide additional details where necessary.
Complete the Medical Information section by entering your primary physician's details and any medications currently taken.
Finally, ensure all signatures are obtained in the Release of Information and Signatures sections before saving your completed form.

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