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. Complete the Treatment Plan by listing any medications and noting 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, as well as sensory abilities.
6. In Activities of Daily Living (ADL), circle all activities where assistance is required.
7. For Advance Care Planning, indicate whether advanced directives or living wills are present and document discussions with family members.
8. Finally, review medications by indicating if a medication review and list have been completed.

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