Care Of Older Adults Assessment Form - CareSource 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the physician's name, date, patient’s name, date of birth, and ID number at the top of the form.
3. In the Pain Assessment section, use the diagram to indicate where the patient's primary pain is located. Mark 'YES' or 'NO' for pain presence and provide comments as needed.
4. For the Treatment Plan, list any medications and specify if under pain management. Rate the level of pain on a scale from 0 to 10.
5. Proceed to Functional Assessment. Circle applicable cognitive and ambulatory statuses, and sensory abilities.
6. In Activities of Daily Living (ADL), circle all tasks where assistance is required.
7. Complete Advance Care Planning by indicating if there are advanced directives or living wills and document discussions with family members.
8. Finally, review medications by indicating whether a medication review was completed and list any medications as necessary.

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