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Doh 4397-2026
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- Click ‘Get Form’ to open the doh 4397 in the editor.
- Begin by entering the resident's name, facility name, and date of evaluation at the top of the form.
- In Section 1, assess communication abilities. Check 'Yes' or 'No' for each question regarding English proficiency and provide details for any language needs.
- Proceed to Section 2 to document the resident's customary routine. Fill in preferred wake-up and bedtime, napping habits, and daily activities.
- In Section 3, evaluate continence status. Answer questions about urinary and bowel function and describe management techniques if applicable.
- For Section 4, assess physical functions such as eating, bathing, dressing, and grooming. Indicate levels of assistance required for each task.
- Complete Section 5 by evaluating cognitive impairment through alertness and orientation questions. Note any behaviors of concern.
- Finally, in Section 6, indicate admission decisions and ensure all signatures are collected before submission.
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