4449c form 2025

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The document is a medical evaluation form (DSS-4449C) used to assess an individual's eligibility for care in adult homes, enriched housing programs, or Assisted Living Programs (ALP). It collects personal and medical information, including diagnoses, medication details, assistance needs, and cognitive assessments. The form aims to ensure that the individual's health and safety needs can be met appropriately in the specified living arrangements.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (186 Votes)

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