Rehabilitation assessment form 2026

1. Click ‘Get Form’ to open the rehabilitation assessment form in the editor.
2. Begin with Section 1, where you will select the Assessment Type and Plan. Choose either 'Initial Assessment' or 'Reassessment' and indicate your coverage plan.
3. In Section 2, fill in the Member/Facility Information. Provide details such as Member Name, Age, Contract Number, and Facility Reviewer for Updates.
4. For initial assessments, complete Section 3 by entering Admission Information including Admission Date, Prior Level of Function, and Facility Doctor Name.
5. Proceed to Section 4 to document Clinical Information/Basics. Fill in vital signs and cognitive status while noting any respiratory treatments or dietary needs.
6. Continue through Sections 5 to 10, detailing Mobility Current Functioning, Self-Care Current Functioning, Clinical Information/Skin Status, Speech Therapy Current Status, and Discharge Plans.
7. Finally, review Section 12 for Additional Notes before saving your completed form. Ensure all required fields are filled accurately.

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