Icf mr level of care evaluation - Alabama Department of Mental Health 2025

1. Click ‘Get Form’ to open the ICF/MR Level of Care Evaluation in the editor.
2. Begin by entering the applicant's name, Medicaid number, facility, and program details in the designated fields at the top of the form.
3. Indicate the mental retardation diagnosis onset by selecting one of the options: Infancy, Developmental (below age 18), or Age 18 years and above.
4. Assess and mark the applicant's limitations in three or more areas of life activity by placing an 'X' in the appropriate boxes for Self-care, IQ Level, Adaptive Functioning Level, Learning, Mobility, Self-direction, and Capacity for independent living.
5. Ensure that a psychological examination has been completed as required. Obtain signatures from both the program representative submitting the form and a physician.
6. Finally, review all entries for accuracy before submitting. Once complete, save your document directly from our platform for easy distribution.

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