Doh 4397-2026

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

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