AHCA Form 1823 Jan 2006doc - 71 18 29-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the resident's name and date of birth at the top of the form. This information is crucial for identification.
3. Fill in known allergies, height, and weight in the designated fields to provide essential health information.
4. In the Health Assessment section, detail medical history, diagnoses, and any physical or sensory limitations that may affect care.
5. Indicate the level of assistance required for ambulation, bathing, dressing, eating, grooming, transferring, and toileting by selecting the appropriate options.
6. Complete sections regarding self-care tasks and general oversight needs by checking the relevant boxes.
7. List all current medications prescribed along with dosage and directions for use. Ensure accuracy for proper medication management.
8. Answer questions about additional conditions or requirements by circling the appropriate numbers and providing comments as necessary.
9. Finally, ensure that a medical professional completes the certification section with their signature and contact details before submitting.

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