Doh 5176-2026

1. Click ‘Get Form’ to open the doh 5176 in the editor.
2. Begin by entering the 'Facility Name' and 'Operating Certificate Number' at the top of the form. This information is essential for identifying your facility.
3. Next, input the 'ACF Capacity' to indicate how many residents your facility can accommodate.
4. In the 'Resident’s Name' section, list each resident's name. Ensure accuracy as this data is crucial for record-keeping.
5. For 'Level of Care', check all applicable boxes (AH, EHP, ALR, EALR, SNALR, ALP) that correspond to each resident's care level.
6. Fill in the 'Room #' where each resident resides. This helps in tracking their location within the facility.
7. Indicate the month and year at the designated area to specify when this report is being completed.
8. If a resident is absent, mark one of the codes (H, V, M, O) in the date box to clarify their status.
9. Finally, complete the 'Days of Care' section by marking occupied days and calculating totals as needed.

Start using our platform today for free to streamline your document editing and completion process!